Clinical Management of Pain in Advanced Lung Cancer
Identifieur interne : 005267 ( Ncbi/Merge ); précédent : 005266; suivant : 005268Clinical Management of Pain in Advanced Lung Cancer
Auteurs : Claribel P. L. Simmons [Royaume-Uni] ; Nicholas Macleod [Royaume-Uni] ; Barry J. A. Laird [Royaume-Uni, Norvège]Source :
- Clinical Medicine Insights. Oncology [ 1179-5549 ] ; 2012.
Abstract
Lung cancer is the most common cancer in the world and pain is its most common symptom. Pain can be brought about by several different causes including local effects of the tumor, regional or distant spread of the tumor, or from anti-cancer treatment. Patients with lung cancer experience more symptom distress than patients with other types of cancer. Symptoms such as pain may be associated with worsening of other symptoms and may affect quality of life. Pain management adheres to the principles set out by the World Health Organization’s analgesic ladder along with adjuvant analgesics. As pain can be caused by multiple factors, its treatment requires pharmacological and non-pharmacological measures from a multidisciplinary team linked in with specialist palliative pain management. This review article examines pain management in lung cancer.
Url:
DOI: 10.4137/CMO.S8360
PubMed: 23115483
PubMed Central: 3474460
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PMC:3474460Le document en format XML
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L." last="Simmons">Claribel P. L. Simmons</name><affiliation wicri:level="4"><nlm:aff id="af1-cmo-6-2012-331">Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. EH4 2XR.</nlm:aff><orgName type="university">Université d'Édimbourg</orgName><country>Royaume-Uni</country><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author><author><name sortKey="Macleod, Nicholas" sort="Macleod, Nicholas" uniqKey="Macleod N" first="Nicholas" last="Macleod">Nicholas Macleod</name><affiliation wicri:level="4"><nlm:aff id="af1-cmo-6-2012-331">Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. EH4 2XR.</nlm:aff><orgName type="university">Université d'Édimbourg</orgName><country>Royaume-Uni</country><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation></author><author><name sortKey="Laird, Barry J A" sort="Laird, Barry J A" uniqKey="Laird B" first="Barry J. A." last="Laird">Barry J. A. Laird</name><affiliation wicri:level="4"><nlm:aff id="af1-cmo-6-2012-331">Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. EH4 2XR.</nlm:aff><orgName type="university">Université d'Édimbourg</orgName><country>Royaume-Uni</country><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="af2-cmo-6-2012-331">European Palliative Care Research Centre (PRC), NTNU, Trondheim, Norway.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Norvège</country><wicri:regionArea>European Palliative Care Research Centre (PRC), NTNU, Trondheim</wicri:regionArea><placeName><settlement type="city">Trondheim</settlement><region type="région" nuts="2">Trøndelag</region></placeName></affiliation></author></analytic><series><title level="j">Clinical Medicine Insights. Oncology</title><idno type="eISSN">1179-5549</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Lung cancer is the most common cancer in the world and pain is its most common symptom. Pain can be brought about by several different causes including local effects of the tumor, regional or distant spread of the tumor, or from anti-cancer treatment. Patients with lung cancer experience more symptom distress than patients with other types of cancer. Symptoms such as pain may be associated with worsening of other symptoms and may affect quality of life. Pain management adheres to the principles set out by the World Health Organization’s analgesic ladder along with adjuvant analgesics. As pain can be caused by multiple factors, its treatment requires pharmacological and non-pharmacological measures from a multidisciplinary team linked in with specialist palliative pain management. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Med Insights Oncol</journal-id><journal-id journal-id-type="iso-abbrev">Clin Med Insights Oncol</journal-id><journal-id journal-id-type="publisher-id">101467911</journal-id><journal-title-group><journal-title>Clinical Medicine Insights. Oncology</journal-title></journal-title-group><issn pub-type="epub">1179-5549</issn><publisher><publisher-name>Libertas Academica</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23115483</article-id><article-id pub-id-type="pmc">3474460</article-id><article-id pub-id-type="doi">10.4137/CMO.S8360</article-id><article-id pub-id-type="publisher-id">cmo-6-2012-331</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Clinical Management of Pain in Advanced Lung Cancer</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Simmons</surname><given-names>Claribel P.L.</given-names></name><xref ref-type="aff" rid="af1-cmo-6-2012-331">1</xref></contrib><contrib contrib-type="author"><name><surname>MacLeod</surname><given-names>Nicholas</given-names></name><xref ref-type="aff" rid="af1-cmo-6-2012-331">1</xref></contrib><contrib contrib-type="author"><name><surname>Laird</surname><given-names>Barry J.A.</given-names></name><xref ref-type="aff" rid="af1-cmo-6-2012-331">1</xref><xref ref-type="aff" rid="af2-cmo-6-2012-331">2</xref><xref ref-type="corresp" rid="c1-cmo-6-2012-331"></xref></contrib></contrib-group><aff id="af1-cmo-6-2012-331"><label>1</label>Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. EH4 2XR.</aff><aff id="af2-cmo-6-2012-331"><label>2</label>European Palliative Care Research Centre (PRC), NTNU, Trondheim, Norway.</aff><author-notes><corresp id="c1-cmo-6-2012-331">Corresponding author email: <email>barry.laird@ed.ac.uk</email></corresp></author-notes><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>08</day><month>10</month><year>2012</year></pub-date><volume>6</volume><fpage>331</fpage><lpage>346</lpage><permissions><copyright-statement>© 2012 the author(s), publisher and licensee Libertas Academica Ltd.</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access"><license-p>This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.</license-p></license></permissions><abstract><p>Lung cancer is the most common cancer in the world and pain is its most common symptom. Pain can be brought about by several different causes including local effects of the tumor, regional or distant spread of the tumor, or from anti-cancer treatment. Patients with lung cancer experience more symptom distress than patients with other types of cancer. Symptoms such as pain may be associated with worsening of other symptoms and may affect quality of life. Pain management adheres to the principles set out by the World Health Organization’s analgesic ladder along with adjuvant analgesics. As pain can be caused by multiple factors, its treatment requires pharmacological and non-pharmacological measures from a multidisciplinary team linked in with specialist palliative pain management. This review article examines pain management in lung cancer.</p></abstract><kwd-group><kwd>analgesia</kwd><kwd>lung cancer</kwd><kwd>pain management</kwd></kwd-group></article-meta></front><floats-group><table-wrap id="t1-cmo-6-2012-331" position="float"><label>Table 1</label><caption><p>Common analgesics for pain in patients with lung cancer.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Analgesic</th><th align="left" valign="top" rowspan="1" colspan="1">Name</th><th align="left" valign="top" rowspan="1" colspan="1">Typical starting dose (oral)</th><th align="left" valign="top" rowspan="1" colspan="1">Maximum dosage</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Acetaminophen</td><td align="left" valign="top" rowspan="1" colspan="1">Paracetamol</td><td align="left" valign="top" rowspan="1" colspan="1">1 g qds</td><td align="left" valign="top" rowspan="1" colspan="1">4 g daily</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Non-steroidal anti-inflammatory</td><td align="left" valign="top" rowspan="1" colspan="1">Ibuprofen</td><td align="left" valign="top" rowspan="1" colspan="1">400 mg tds</td><td align="left" valign="top" rowspan="1" colspan="1">2.4 g daily</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Weak opioid</td><td align="left" valign="top" rowspan="1" colspan="1">Codeine phosphate</td><td align="left" valign="top" rowspan="1" colspan="1">30 mg–60 mg qds</td><td align="left" valign="top" rowspan="1" colspan="1">240 mg daily</td></tr><tr><td align="left" valign="top" rowspan="3" colspan="1">Strong opioid (Dose requirements should be individually titrated according to pain, analgesic response to pain and side effects)</td><td align="left" valign="top" rowspan="1" colspan="1">Morphine</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg every 4–6 hours for opioid naïve patients</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Oxycodone</td><td align="left" valign="top" rowspan="1" colspan="1">5 mg every 4–6 hours</td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Hydromorphone</td><td align="left" valign="top" rowspan="1" colspan="1">1.3 mg every 4–6 hours (immediate release hydromorphone capsules are only available in strengths of 1.3 mg and 2.6 mg)</td><td align="left" valign="top" rowspan="1" colspan="1">(Modified release hydromorphone capsules are only available in strengths of 2 mg, 4 mg, 8 mg, 16 mg and 24 mg)</td></tr><tr><td align="left" valign="top" rowspan="4" colspan="1">Tricyclic antidepressants</td><td align="left" valign="top" rowspan="1" colspan="1">Amitriptyline</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg nocte</td><td align="left" valign="top" rowspan="1" colspan="1">75 mg (neuropathic pain)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Nortriptyline</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg nocte</td><td align="left" valign="top" rowspan="1" colspan="1">75 mg (neuropathic pain)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Imipramine</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg daily</td><td align="left" valign="top" rowspan="1" colspan="1">75 mg (neuropathic pain)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Clomipramine</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg daily</td><td align="left" valign="top" rowspan="1" colspan="1">75 mg (neuropathic pain)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Serotonin and noradrenaline reuptake inhibitor</td><td align="left" valign="top" rowspan="1" colspan="1">Duloxetine</td><td align="left" valign="top" rowspan="1" colspan="1">60 mg od</td><td align="left" valign="top" rowspan="1" colspan="1">120 mg</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Selective serotonin reuptake inhibitors</td><td align="left" valign="top" rowspan="1" colspan="1">Citalopram</td><td align="left" valign="top" rowspan="1" colspan="1">20 mg</td><td align="left" valign="top" rowspan="1" colspan="1">60 mg</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Alpha—2—adrenergic agonists</td><td align="left" valign="top" rowspan="1" colspan="1">Clonidine</td><td align="left" valign="top" rowspan="1" colspan="1">50 mcg bd</td><td align="left" valign="top" rowspan="1" colspan="1">150 mcg</td></tr><tr><td align="left" valign="top" rowspan="4" colspan="1">Anticonvulsants</td><td align="left" valign="top" rowspan="1" colspan="1">Gabapentin</td><td align="left" valign="top" rowspan="1" colspan="1">300 mg gradually titrated upwards, given in divided doses, usually tds</td><td align="left" valign="top" rowspan="1" colspan="1">3.6 g</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Pregabalin</td><td align="left" valign="top" rowspan="1" colspan="1">75 mg bd</td><td align="left" valign="top" rowspan="1" colspan="1">300 mg</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Carbamazepine</td><td align="left" valign="top" rowspan="1" colspan="1">100 mg od</td><td align="left" valign="top" rowspan="1" colspan="1">1.6 g</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Clonazepam</td><td align="left" valign="top" rowspan="1" colspan="1">500 mcg nocte</td><td align="left" valign="top" rowspan="1" colspan="1">4–8 mg</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">NMDA receptor antagonists</td><td align="left" valign="top" rowspan="1" colspan="1">Ketamine</td><td align="left" valign="top" rowspan="1" colspan="1">10 mg qds</td><td align="left" valign="top" rowspan="1" colspan="1">400 mg</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Corticosteroid</td><td align="left" valign="top" rowspan="1" colspan="1">Dexamethasone</td><td align="left" valign="top" rowspan="1" colspan="1">4–8 mg od</td><td align="left" valign="top" rowspan="1" colspan="1">Varies according to indication</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-cmo-6-2012-331"><p><bold>Abbreviations:</bold> od, once daily; bd, twice daily; tds, three times daily; qds, four times daily; nocte, night-time.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-cmo-6-2012-331" position="float"><label>Table 2</label><caption><p>Common causes of pain in patients with lung cancer.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Intra-thoracic causes of pain</th><th align="left" valign="top" rowspan="1" colspan="1">Extra-thoracic causes of pain</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1"><list list-type="bullet"><list-item><p>Chest pain</p><list list-type="simple"><list-item><p>○ Pleural invasion</p></list-item><list-item><p>○ Chest wall invasion</p></list-item><list-item><p>○ Obstructive pneumonitis</p></list-item><list-item><p>○ Pulmonary embolus</p></list-item><list-item><p>○ Tumor invasion</p></list-item><list-item><p>○ Costopleural syndrome</p></list-item></list></list-item></list></td><td align="left" valign="top" rowspan="1" colspan="1"><list list-type="bullet"><list-item><p>Metastasis</p><list list-type="simple"><list-item><p>○ Bone</p></list-item><list-item><p>○ Liver</p></list-item><list-item><p>○ Brain</p></list-item></list></list-item><list-item><p>Hypertrophic osteo-arthropathy</p></list-item></list></td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Norvège</li><li>Royaume-Uni</li></country><region><li>Trøndelag</li><li>Écosse</li></region><settlement><li>Trondheim</li><li>Édimbourg</li></settlement><orgName><li>Université d'Édimbourg</li></orgName></list><tree><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Simmons, Claribel P L" sort="Simmons, Claribel P L" uniqKey="Simmons C" first="Claribel P. L." last="Simmons">Claribel P. L. Simmons</name></region><name sortKey="Laird, Barry J A" sort="Laird, Barry J A" uniqKey="Laird B" first="Barry J. A." last="Laird">Barry J. A. Laird</name><name sortKey="Macleod, Nicholas" sort="Macleod, Nicholas" uniqKey="Macleod N" first="Nicholas" last="Macleod">Nicholas Macleod</name></country><country name="Norvège"><region name="Trøndelag"><name sortKey="Laird, Barry J A" sort="Laird, Barry J A" uniqKey="Laird B" first="Barry J. A." last="Laird">Barry J. A. Laird</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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