Cancer Pain and Analgesia
Identifieur interne : 002602 ( Istex/Corpus ); précédent : 002601; suivant : 002603Cancer Pain and Analgesia
Auteurs : Paul J. Christo ; Danesh MazloomdoostSource :
- Annals of the New York Academy of Sciences [ 0077-8923 ] ; 2008-09.
Abstract
Pain ranges in prevalence from 14–100% among cancer patients and occurs in 50–70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over‐the‐counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering.
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DOI: 10.1196/annals.1414.033
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This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over‐the‐counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. 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type="first">Danesh</forename><surname>Mazloomdoost</surname></persName><affiliation>Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA<address><country key="US"></country></address></affiliation></author><idno type="istex">527BA0523BD8BD05A586FC975C56F81038F6B6CD</idno><idno type="DOI">10.1196/annals.1414.033</idno><idno type="unit">NYAS1138033</idno><idno type="toTypesetVersion">file:NYAS.NYAS1138033.pdf</idno></analytic><monogr><title level="j" type="main">Annals of the New York Academy of Sciences</title><title level="j" type="alt">ANNALS OF NEW YORK ACADEMY SCIENCES</title><idno type="pISSN">0077-8923</idno><idno type="eISSN">1749-6632</idno><idno type="book-DOI">10.1111/(ISSN)1749-6632</idno><idno type="book-part-DOI">10.1196/nyas.2008.1138.issue-1</idno><idno type="product">NYAS</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">1138</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="278">278</biblScope><biblScope unit="page" to="298">298</biblScope><biblScope unit="page-count">21</biblScope><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2008-09"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p>Pain ranges in prevalence from 14–100% among cancer patients and occurs in 50–70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over‐the‐counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">cancer</term><term xml:id="k2">pain</term><term xml:id="k3">analgesia</term><term xml:id="k4">opioids</term><term xml:id="k5">addiction</term><term xml:id="k6">barriers to pain relief</term><term xml:id="k7">cancer pain</term><term xml:id="k8">adjuvant therapies</term><term xml:id="k9">nonopioid therapies</term><term xml:id="k10">co‐analgesics</term><term xml:id="k11">malignancy</term><term xml:id="k12">therapies</term><term xml:id="k13">WHO 3‐step analgesic ladder</term></keywords><classCode scheme="tocHeading1">Part VIII. Pain Control, Palliative, and Other Therapies</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/527BA0523BD8BD05A586FC975C56F81038F6B6CD/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Inc</publisherName><publisherLoc>Malden, USA</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1749-6632</doi><issn type="print">0077-8923</issn><issn type="electronic">1749-6632</issn><idGroup><id type="product" value="NYAS"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="ANNALS OF NEW YORK ACADEMY SCIENCES">Annals of the New York Academy of Sciences</title></titleGroup></publicationMeta><publicationMeta level="part" position="09001"><doi origin="wiley">10.1196/nyas.2008.1138.issue-1</doi><titleGroup><title type="main">Recent Advances in Clinical Oncology</title></titleGroup><numberingGroup><numbering type="journalVolume" number="1138">1138</numbering><numbering type="journalIssue">1</numbering></numberingGroup><coverDate startDate="2008-09">September 2008</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="34" status="forIssue"><doi origin="wiley">10.1196/annals.1414.033</doi><idGroup><id type="unit" value="NYAS1138033"></id></idGroup><countGroup><count type="pageTotal" number="21"></count></countGroup><titleGroup><title type="tocHeading1">Part VIII. Pain Control, Palliative, and Other Therapies</title></titleGroup><copyright>© 2008 New York Academy of Sciences</copyright><eventGroup><event type="firstOnline" date="2008-09-29"></event><event type="publishedOnlineFinalForm" date="2008-09-29"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-06"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:4.0.1" date="2014-03-19"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-14"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="278">278</numbering><numbering type="pageLast" number="298">298</numbering></numberingGroup><correspondenceTo>Address for correspondence: Paul J. Christo, M.D., M.B.A., Assistant Professor, Director, Multidisciplinary Pain Fellowship Director, Pain Treatment Center, Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 301, Baltimore, MD 21205. Voice: +410‐955‐1818; fax: +410‐502‐6730. <email>pchristo@jhmi.edu</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:NYAS.NYAS1138033.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="5"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="150"></count><count type="linksCrossRef" number="130"></count></countGroup><titleGroup><title type="main">Cancer Pain and Analgesia</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Paul J.</givenNames><familyName>Christo</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Danesh</givenNames><familyName>Mazloomdoost</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="US"><unparsedAffiliation>Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">cancer</keyword><keyword xml:id="k2">pain</keyword><keyword xml:id="k3">analgesia</keyword><keyword xml:id="k4">opioids</keyword><keyword xml:id="k5">addiction</keyword><keyword xml:id="k6">barriers to pain relief</keyword><keyword xml:id="k7">cancer pain</keyword><keyword xml:id="k8">adjuvant therapies</keyword><keyword xml:id="k9">nonopioid therapies</keyword><keyword xml:id="k10">co‐analgesics</keyword><keyword xml:id="k11">malignancy</keyword><keyword xml:id="k12">therapies</keyword><keyword xml:id="k13">WHO 3‐step analgesic ladder</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p>Pain ranges in prevalence from 14–100% among cancer patients and occurs in 50–70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over‐the‐counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Cancer Pain and Analgesia</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Cancer Pain and Analgesia</title></titleInfo><name type="personal"><namePart type="given">Paul J.</namePart><namePart type="family">Christo</namePart><affiliation>Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Danesh</namePart><namePart type="family">Mazloomdoost</namePart><affiliation>Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Inc</publisher><place><placeTerm type="text">Malden, USA</placeTerm></place><dateIssued encoding="w3cdtf">2008-09</dateIssued><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">5</extent><extent unit="references">150</extent></physicalDescription><abstract lang="en">Pain ranges in prevalence from 14–100% among cancer patients and occurs in 50–70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over‐the‐counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering.</abstract><subject lang="en"><genre>keywords</genre><topic>cancer</topic><topic>pain</topic><topic>analgesia</topic><topic>opioids</topic><topic>addiction</topic><topic>barriers to pain relief</topic><topic>cancer pain</topic><topic>adjuvant therapies</topic><topic>nonopioid therapies</topic><topic>co‐analgesics</topic><topic>malignancy</topic><topic>therapies</topic><topic>WHO 3‐step analgesic ladder</topic></subject><relatedItem type="host"><titleInfo><title>Annals of the New York Academy of Sciences</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0077-8923</identifier><identifier type="eISSN">1749-6632</identifier><identifier type="DOI">10.1111/(ISSN)1749-6632</identifier><identifier type="PublisherID">NYAS</identifier><part><date>2008</date><detail type="title"><title>Recent Advances in Clinical Oncology</title></detail><detail type="volume"><caption>vol.</caption><number>1138</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>278</start><end>298</end><total>21</total></extent></part></relatedItem><identifier type="istex">527BA0523BD8BD05A586FC975C56F81038F6B6CD</identifier><identifier type="DOI">10.1196/annals.1414.033</identifier><identifier type="ArticleID">NYAS1138033</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2008 New York Academy of Sciences</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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