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When morphine does not work.

Marie Fallon1

  • 1Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, Crewe Road, Edinburgh, EH4 2XR, UK. Marie.Fallon@ed.ac.uk

Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
|February 16, 2008
PubMed
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Approximately 70% of cancer patients experience pain, with 20% not responding to standard World Health Organisation (WHO) guidelines. This review focuses on managing challenging cancer pain unresponsive to opioids.

Area of Science:

  • Oncology
  • Pain Management
  • Palliative Care

Background:

  • Cancer pain affects up to 70% of patients, often worsening with disease progression.
  • The World Health Organisation (WHO) three-step analgesic ladder is effective for about 80% of cancer pain cases.
  • Non-pharmacological and tumouricidal therapies are crucial adjuncts to pharmacological approaches.

Purpose of the Study:

  • To review management strategies for the 20% of cancer patients with pain refractory to standard WHO guidelines.
  • To address severe cancer pain inadequately controlled by morphine or other strong opioids.
  • To explore approaches for challenging cancer pain scenarios, including opioid-irrelevant, partially responsive, unresponsive, and opioid-excess-related pain.

Main Methods:

  • Review of existing literature and clinical guidelines on cancer pain management.

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  • Analysis of patient subgroups with suboptimal response to WHO analgesic ladder.
  • Categorization of refractory cancer pain into opioid-irrelevant, partially responsive, unresponsive, or related to opioid excess.

    • Main Results:

    • Standard WHO guidelines are insufficient for approximately 20% of cancer patients with severe pain.
    • Refractory cancer pain requires tailored, "lateral thought" management beyond standard opioid titration.
    • Categorizing pain based on opioid response is essential for guiding treatment decisions.

    Conclusions:

    • Effective management of refractory cancer pain necessitates strategies beyond the standard WHO three-step approach.
    • Understanding the specific mechanisms of pain (opioid-irrelevant, partially responsive, unresponsive, opioid excess) is key.
    • Advanced and individualized treatment plans are critical for the 20% of cancer patients with challenging pain.