Pain in far-advanced cancer

Twycross, Robert; Fairfield, S.

doi:10.1016/0304-3959(82)90137-3

Cited by 266 publications

(99 citation statements)

References 2 publications

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“…10 Of course, we must understand the pathophysiology of each individual pain, recognising that cancer patients will typically have multiple pains. 11 But a detailed pain assessment demands that we undertake a more holistic review of each individual patient in the context of his or her unique circumstances. Pain management requires a multi-dimensional and inter-disciplinary approach to assessment, and thereafter, therapeutic strategies will require the use of both pharmacological and non-pharmacological interventions.…”

Section: Nature Of Painmentioning

confidence: 99%

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

O’Brien

Kane

2014

British Journal of Pain

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The vast majority of cancer patients will experience pain during the course of their illness. Thankfully, in most instances, the consistent application of analgesic guidelines, tailored to the unique needs of each individual patient, will deliver a satisfactory outcome. These guidelines recommend the skilled use of analgesic medications, often in conjunction with a range of adjuvant therapies as may be required. Despite the consistent and rational application of such strategies, it is recognised that a small but significant proportion of cancer patients continue to experience more refractory pain. In addition, these patients may experience a plethora of unwanted dose-limiting side effects associated with their analgesic medication, sometimes even at low dose. All such patients with more complex and refractory pain syndromes require a more comprehensive review and many will require interventional therapy and/or adjuvant approaches. Unfortunately, the availability and accessibility of such services are variable. Even in circumstances in which palliative medicine and pain services co-exist in the same region, there may be poor integration between the two services. Each specialty area holds a unique set of skills and competencies, yet there is considerable overlap. Patient care and outcomes will be enhanced by establishing more formal relationships between these two specialty areas.

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Section: Nature Of Painmentioning

confidence: 99%

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

O’Brien

Kane

2014

British Journal of Pain

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“…Pain that originates from injury to muscle or connective tissue is frequent in patients with cancer [125]. The efficacy of so-called muscle relaxants and other drugs commonly used for the treatment of musculoskeletal pain has not been evaluated in cancer patients.…”

Section: Adjuvant Analgesics Used For Musculoskeletal Painmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, α α 2 -adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions. The Oncologist 2004;9:571-591

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“…These systems have been converted into a five-point pain scale to classify the intensity of pain as follows: mild, moderate, severe, very severe, and unbearable. 10 Severity of pain and pain medication at the start of combined treatment are summarized in Table 2.…”

Section: Patient and Tumor Characteristicsmentioning

confidence: 99%

“…A good palliative effect was defined as either a pain reduction (with equal pain medication) by at least 2 points on the 5-point pain scale 10 or a reduction by at least 1 point if accompanied by a worthwhile decrease (in potency and/or quantity) in pain medication, both for at least 1 month. A minor palliative effect was defined as a decrease of pain and/or pain medication for at least 1 month, but less than the decrease in pain defined as a good palliative effect.…”

Section: Palliative Effectmentioning

confidence: 99%

Reirradiation and hyperthermia in rectal carcinoma

Juffermans

Hanssens

Putten

et al. 2003

Cancer

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BACKGROUNDThe objective of this study was to evaluate the palliative effect of reirradiation and hyperthermia in patients with unresectable, recurrent colorectal carcinoma.METHODSThe medical records of 54 patients with unresectable, recurrent colorectal carcinoma that caused pain and who were treated with reirradiation and hyperthermia, were evaluated retrospectively. Previous radiotherapy was given up to a total dose ranging from 25–70 grays (Gy). The median interval between prior radiotherapy and reirradiation was 22 months (range, 4–97 months). The total reirradiation dose varied from 24 Gy to 32 Gy given in fractions of 4 Gy twice weekly. Three or four hyperthermia treatments were given once weekly. Toxicity was registered. The influence of World Health Organization (WHO) performance status, maximum tumor dimension, and time between first radiotherapy and reirradiation on therapeutic outcome was evaluated. The results of this study were compared with published results on patients who received radiotherapy with or without hyperthermia.RESULTSForty‐seven patients (87%) completed the planned treatment schedule. The maximum toxicity was Grade 2. All patients were evaluated for palliative effect. The median follow‐up was 10 months. A good or complete palliative effect was achieved in 72% of patients for a median duration of 6 months. Patients who had a better WHO performance status, smaller tumors, and a longer interval between first radiotherapy and reirradiation had slightly better outcomes, although none of those parameters reached statistical significance.CONCLUSIONSThe described combined treatment was feasible and well tolerated. Comparison of results from radiotherapy plus hyperthermia with results after radiotherapy alone suggested that additional hyperthermia prolonged the duration of palliation. Firm proof of the contribution of hyperthermia will require performing a Phase III study. Cancer 2003. © 2003 American Cancer Society.DOI 10.1002/cncr.11719

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Pain in far-advanced cancer

Cited by 266 publications

References 2 publications

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

Adjuvant Analgesics in Cancer Pain Management

Reirradiation and hyperthermia in rectal carcinoma

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