Advances in cancer pain management
McDonnell FJ, Sloan JW, Hamann SR.
Palliative Care Service,
Department of Anesthesiology,
University of Kentucky College of Medicine,
Rose Street, Lexington, KY 40536, USA.
Curr Pain Headache Rep 2001 Jun; 5(3):265-74


Control of malignant pain and related symptoms is paramount to clinical success in caring for cancer patients. To achieve the best quality of life for patients and families, oncologists and palliative care clinicians must work together to understand problems related to psychologic, social, and spiritual pain. Pain is the primary problem targeted for control using the World Health Organization's (WHO) analgesic ladder. This article focuses on increased knowledge of analgesic action that may enable expansion of the WHO analgesic ladder to fulfill the broader objectives of palliative medicine. We discuss clinical experience with several classes of drugs that are currently used to treat cancer pain: 1) nonsteroidal anti-inflammatory drugs, with emphasis on cyclooxygenase-2 inhibitors; 2) opioid analgesics, with specific emphasis on methadone and its newly recognized value in cancer pain; 3) ketamine, an antagonist at N-methyl-d-aspartate receptors; and 4) bisphosphonates, used for pain resulting from bone metastases. New concepts that compare molecular actions of morphine at excitatory opioid receptors, and methadone at nonopioid receptor systems, are presented to underscore the importance of balancing central nervous system excitatory (anti-analgesic) versus inhibitory (analgesic) influences.
Back pain
Cancer pain
Opioid receptors
Neuropathic pain
Down's syndrome
NMDA anatagonists
Spinal opioid therapy
Endomorphins 1 and 2
The Pleasures of Opium
Opioids and anaesthesia
Is morphine a smart drug?
Endomorphins and the mouse
Pain therapy: why voodoo works
Pain and analgesia: mechanisms
Nociception, pain and antinociception

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