A validation study of the WHO analgesic ladder: a two-step vs three-step strategy

Maltoni, Marco; Scarpi, Emanuela; Modonesi, Caterina; Passardi, Alessandro; Calpona, Sebastiano; Turriziani, A; Speranza, R; Tassinari, Davide; Magnani, Pierantonio; Saccani, Denis; Montanari, Luigi; Roudnas, B.; Amadori, Dino

doi:10.1007/s00520-005-0807-6

Cited by 115 publications

(70 citation statements)

References 20 publications

(27 reference statements)

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“…Maltoni et al [8] evaluated the efficacy of an innovative two-step strategy for the treatment of chronic cancer pain to determine if it was more effective than the conventional three-step strategy. They reported that of the 54 patients in their study, the patients in the "two-step" group had better pain control and shorter periods of pain, but experienced more adverse effects, than the patients in the "three-step" group.…”

Section: The World Health Organization's Three-step Analgesic Laddermentioning

confidence: 99%

Current concepts of pain management for cancer patients

2008

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Pain management is one of the most important issues confronted when treating patients with malignant diseases. Since its release/publication in 1986, the World Health Organization's three-step analgesic ladder has helped to greatly improve pain management in cancer patients. However, many questions about this three-step analgesic ladder have been raised and its application in the clinical setting remains a controversial subject. This review article explores the frontline treatment of cancer pain with morphine and the different routes of fentanyl administration used in cancer pain management. The combination of multiple opiates/opioids has been shown to result in more effective cancer pain management; however, the exact benefits of such opiate/opioid combinations have yet to be established. This article also discusses recent advances in the topical application of morphine and in the combination of ketamine and morphine. It explores the updated treatment principles of neuropathic pain in advanced-stage cancer patients, which incorporate the use of anti-depressants, anti-convulsants, and opioids. Finally, this article reviews the available data and clarifies the general principles for using opioids in cancer patients with renal insufficiency. We hope that this information will be helpful in improving pain management in cancer patients and in facilitating further research.

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Section: The World Health Organization's Three-step Analgesic Laddermentioning

confidence: 99%

Current concepts of pain management for cancer patients

2008

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“…Therefore, a RCT is required to be conducted for the role of 2 nd step (Marinangeli et al, 2004;Maltoni et al, 2005;.…”

Section: Who Guideline For Steps and Pharmacological Treatmentmentioning

confidence: 99%

Cancer Pain Prevalence and its Management

Arslan¹,

Koca²,

Akar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Pain is a public health problem affecting more than half of cancer patients. Despite the success of the protocols currently used, pain cannot still be reduced satisfactorily in the large majority of patients. In order to improve pain management, all healthcare professionals involved with pain should have sufficient knowledge on pain assessment and treatment, and should inform patients to prevent patient-related barriers. In this compilation, the prevalence values and the treatment methods of cancer pain, and the barriers to pain management have been assessed.

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“…On the other hand, two randomized controlled trials demonstrated that using a Step 3 opioid first (two-step strategy) is significantly more effective than using the three-step strategy, in improving cancer pain (36,37). However, some adverse events such as nausea or constipation tended to be more frequent in the two-step strategy group in these studies.…”

Section: Patients With Moderate-to-severe Pain or Inadequately Contromentioning

confidence: 63%

Clinical Guideline for Pharmacological Management of Cancer Pain: The Japanese Society of Palliative Medicine Recommendations

Yamaguchi

Shima

Morita

et al. 2013

Japanese Journal of Clinical Oncology

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Pain is the most frequent and distressing symptom in cancer patients. As part of a worldwide effort to improve the quality of pain control, several clinical guidelines for the management of cancer pain have been published and revised in the last decade. The Japanese Society of Palliative Medicine first published a Japanese clinical guideline for the management of cancer pain in 2000. Since then, many clinical studies concerning cancer pain management have been conducted, new drugs have become available in Japan and the methodology of developing a guideline has been refined. Therefore, we decided to develop a novel clinical guideline. This review paper summarizes the recommendations and the rationales of this new clinical guideline for the pharmacological management of cancer pain. In addition, a short summary of the clinical guideline development process is provided. This new Japanese Society of Palliative Medicine guideline highlights the importance of conducting well-designed studies to identify the best practices in cancer pain management.

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A validation study of the WHO analgesic ladder: a two-step vs three-step strategy

Abstract: Our preliminary data would seem to suggest that a direct move to the third step of the WHO analgesic ladder is feasible and could reduce some pain scores but also requires careful management of side effects.

Cited by 115 publications

References 20 publications

Current concepts of pain management for cancer patients

Current concepts of pain management for cancer patients

Cancer Pain Prevalence and its Management

Clinical Guideline for Pharmacological Management of Cancer Pain: The Japanese Society of Palliative Medicine Recommendations

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