Clinical guidance outlines mechanism-based multimodal strategies for cancer pain, indicating the need to move beyond traditional step-ladder approaches to reduce adverse effects.
It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.
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Raphael et al. (2010) studied this question.
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