An overview of the current drug treatment strategies for moderate to severe, chronic malignant tumor-related pain

ABSTRACT

Introduction

The pharmacological management of cancer pain is a complex issue that requires knowledge and experience in the use of analgesics. The aim of this expert review is to provide a panorama of the pharmacological strategies in cancer pain management

Areas covered

Opioid dose titration is a delicate process regarding the start of opioid treatment in different clinical conditions. How to improve the opioid response is a fundamental step, which includes different strategies when an initial treatment with opioids fails. The use of adjuvants is another relevant issue that should be considered in some specific circumstances to optimize the management of cancer pain management. Some clinical conditions, such as neuropathic pain and breakthrough pain, deserve a special attention. Relevant literature was selected to provide an overview of cancer pain management strategies.

Expert opinion

Opioid therapy still remains the cornerstone of pharmacological management of cancer pain. Opioids should be used according to the level of tolerance, also personalizing the treatment (route, drug, and dosing). Adjuvant drugs may help in specific conditions, although their use should be balanced with the adverse effects. Breakthrough pain requires expertise in tailoring a treatment according to patient’s profile and characteristics of episodes.

KEYWORDS:

• Cancer pain
• opioids
• palliative care
• analgesics
• breakthrough pain
• neuropathic pain
• opioid switching

Article highlights

• The pharmacological management of cancer pain allows an acceptable pain control in the majority of patients.

• Different phases of disease require different approaches, such as opioid-dose titration, dose changes, and opioid switching in individuals.

• Adjuvant drugs may be helpful in particular conditions in selected patients.

• Different options are available for the treatment of breakthrough pain episodes. Drugs will be chosen according to episode’s characteristics

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.