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15 - Neuraxial analgesia

from SECTION IV - PHARMACOLOGICAL TREATMENT

Published online by Cambridge University Press:  06 July 2010

By
LEWIS C. HOLFORD  and
MICHAEL COUSINS
Edited by
Eduardo D. Bruera  and
Russell K. Portenoy
LEWIS C. HOLFORD
Affiliation:
University of Sydney at Royal North Shore Hospital
MICHAEL COUSINS
Affiliation:
University of Sydney at Royal North Shore Hospital
Eduardo D. Bruera
Affiliation:
University of Texas, Houston
Russell K. Portenoy
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

Introduction

Improvements in the understanding of the pathophysiology of pain, increased availability of pharmacological agents, adoption of different modes of drug administration, and development of comprehensive multidisciplinary care all have contributed to increasing the number of patients with effective control of cancer pain. The Guidelines for Cancer Pain Relief established by the World Health Organization (WHO) have been useful in emphasizing the effectiveness of oral morphine as a mainstay of cancer pain treatment. Although the analgesic “ladder” drew attention to the importance of using opioids of increasing potency and adding adjuvant therapies as necessary, the strategy today is to tailor the ingredients of a multimodal oral regimen to each patient's requirements at a particular stage of the disease. Several algorithms exist for the treatment of cancer pain, including the WHO Cancer Pain Ladder and the Agency for Healthcare Policy and Research (AHCPR) and National Cancer Care Network (NCCN) cancer pain treatment guidelines. However, 10%–20% of patients will require more intensive measures to control pain, particularly in the terminal phases of their illness. Treatment options include primary therapies such as radiotherapy, chemotherapy, and surgery to reduce pain in specific cases; parenteral or spinal administration of analgesic agents; neurolytic blocks; and surgical neuroablative procedures. In a prospective study of 2118 patients with cancer pain managed according to WHO guidelines, neuraxial analgesic administration (epidural and intrathecal) was used in 3% of the patients.

Type
Chapter
Information
Cancer Pain
Assessment and Management
 , pp. 287 - 312
Publisher: Cambridge University Press
Print publication year: 2009

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