Advances in Cancer Pain Management

Undertreatment of cancer pain remains a worldwide problem. World Health Organization (WH0) and national initiatives are addressing this important issue and several significant, recent advances have been made. There has been more widespread adoption of the WHO method for relief of cancer pain, which is based on a three step analgesic ladder and regular, around-the-clock oral medication. Until recently, many countries have not allowed oral morphine, but there is now more widespread availability of oral preparations of this drug. Epidural administration of morphine and other analgesics is being employed successfully in selected patients. The importance of using anti-inflammatory agents, especially the nonsteroidal anti-inflammatory drugs (NSAIDs) is being more widely recognized. There is an increased awareness of the importance of differentiating nociceptive and neuropathic pain. Tricyclic antidepressants and anticonvulsants are often effective in the latter, and good experience with the use of local anesthetic congeners (mexiletine, flecainide) in neuropathic pain management is increasing. There is a growing awareness of the importance of applying cancer pain management within the context of a comprehensive program of palliative care.