The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

Ferreira, Kuitéria Ribeiro; Kimura, Miako; Teixeira, Manoel Jacobsen

doi:10.1007/s00520-006-0086-x

Cited by 147 publications

(52 citation statements)

References 53 publications

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“…Current estimates suggest that adequate analgesia is not achieved in all cancer patients using the World Health Organization's (WHO's) analgesic ladder (Azevedo et al, 2006). Understanding the mechanisms related to the generation and maintenance of cancer pain is needed for the development of novel and more efficacious therapies to treat this condition.…”

Section: Introductionmentioning

confidence: 99%

The cannabinoid receptor agonist, WIN 55, 212-2, attenuates tumor-evoked hyperalgesia through peripheral mechanisms

2008

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Several lines of evidence suggest that cannabinoids can attenuate various types of pain and hyperalgesia through peripheral mechanisms. The development of rodent cancer pain models has provided the opportunity to investigate novel approaches to treat this common form of pain. In the present study, we examined the ability of peripherally administered cannabinoids to attenuate tumorevoked mechanical hyperalgesia in a murine model of cancer pain. Unilateral injection of osteolytic fibrosarcoma cells into and around the calcaneus bone resulted in tumor formation and mechanical hyperalgesia in the injected hindpaw. Mechanical hyperalgesia was defined as an increase in the frequency of paw withdrawals to a suprathreshold von Frey filament (3.4mN) applied to the plantar surface of the hindpaw. WIN 55, 212-2 (1.5 to 10μg) injected subcutaneously into the tumor-bearing hindpaw produced a dose-dependent decrease in paw withdrawal frequencies to suprathreshold von Frey filament stimulation. Injection of WIN 55,212-2 (10μg) into the contralateral hindpaw did not decrease paw withdrawal frequencies in the tumor-bearing hindpaw. Injection of the highest antihyperalgesic dose of WIN 55,212-2 (10μg) did not produce catalepsy as determined by the bar test. Co-administration of WIN 55,212-2 with either cannabinoid 1 (AM251) or cannabinoid 2 (AM630) receptor antagonists attenuated the antihyperalgesic effects of WIN 55, 212-2. In conclusion, peripherally administered WIN 55,212-2 attenuated tumor-evoked mechanical hyperalgesia by activation of both peripheral cannabinoid 1 and cannabinoid 2 receptors. These results suggest that peripherally-administered cannabinoids may be effective in attenuating cancer pain.

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Section: Introductionmentioning

confidence: 99%

The cannabinoid receptor agonist, WIN 55, 212-2, attenuates tumor-evoked hyperalgesia through peripheral mechanisms

2008

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“…The ladder, with diseasespecifi c modifi cations, has been shown to provide adequate pain control for 96% of renal failure patients and 45-100% of cancer patients, including those with neuropathic pain. [14][15][16] Polypharmacy is common and up to one-third of palliative patients are at risk of signifi cant drug interactions. 17 Several agents, including tramadol, fentanyl and some antidepressants, can cause serotoninergic syndrome if used together.…”

Section: Pharmacological Approachesmentioning

confidence: 99%

Managing pain in advanced illness

2014

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“…Several observational studies have revealed the efficacy of this WHO analgesic ladder (34,35). Therefore, using the three-step strategy is likely to be safe and effective.…”

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

confidence: 99%

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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The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

Abstract: However, the evidence that they provide is insufficient to grant the effectiveness of the WHO guidelines because a controlled clinical trial of this intervention has never been published.

Cited by 147 publications

References 53 publications

The cannabinoid receptor agonist, WIN 55, 212-2, attenuates tumor-evoked hyperalgesia through peripheral mechanisms

The cannabinoid receptor agonist, WIN 55, 212-2, attenuates tumor-evoked hyperalgesia through peripheral mechanisms

Managing pain in advanced illness

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

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