Pharmacologic Approaches to the Control of Cancer Pain

Abstract

Numerous surveys suggest that 30-50 percent of cancer patients who are undergoing active therapy and more than threequarters of those who have advanced disease suffer moderate to severe pain. There is abundant evidence that pain is usually poorly assessed and inadequately treated. The author describes in detail three steps that are required for the pharmacologic management of cancer pain: a comprehensive assessment, selection of appropriate analgesic modalities, and consideration of pharmacologic issues. He also discusses a model approach to pharmacologic treatment advocated by the World Health Organization called the "analgesic ladder," which involves three categories of analgesic drugs-nonsteroidal anti-inflammatory drugs, opioid analgesics, and adjuvant analgesics. If expertly applied, this approach produces analgesia in approximately 70 percent of patients who have cancer pain.