Cancer Pain Management: Continuum Approach

Just as the sensation of pain can manifest itself in a variety of ways, there is a broad range of options for managing pain. Treatment with analgesic is the basis of pain management for cancer patients. However, every patient is unique and responds to medication differently, so a variety of doses and drug combinations may be tested to determine the most effective pain relief methods. Patient education and knowledge about chronic pain treatment options also can make a significant difference in helping them navigate the pain management continuum.

The World Health Organization (WHO) summarizes the basic pharmacologic principles of cancer pain management in the form of an “analgesic ladder”, whereby increasingly severe pain is treated with increasingly potent analgesics. The three rungs of this ladder include: nonpioids (including acetaminophen and non-steroidal anti-inflammatory drugs [NSAIDSs] for mild main; weak opioids (such as codeine and propoxyphene) for moderate pain; and potent opioids (including morphine and methadone) for treating severe pain. As treatment progresses, adjuvant drugs and interventional therapies may also be added as needed to alleviate pain in case a spine surgery couldn’t help.

This basic approach to pain management can also be represented as a continuum that includes interventional techniques – which may be appropriate as pain intensity progresses or when a patient is unable to take medicine by mouth. In general, however, according to Dr. Lynne Carr Columbus, “the key steps to ensure adequate pain control are: an accurate pain diagnosis; appropriate use of surgical, medical and radiation interventions; proper application of noninvasive and invasive pain relief techniques; and adequate and ongoing follow-up to adjust the treatment approach to the patient’s changing clinical condition.

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