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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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[Update palliative pain therapy].

R Rolke1, S Rolke2, S Hiddemann3

  • 1Klinik für Palliativmedizin, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. rrolke@ukaachen.de.

Der Internist
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Summary
This summary is machine-generated.

Effective cancer pain management involves understanding pain mechanisms and utilizing a stepwise approach. Non-opioid analgesics, opioids, and co-analgesics are key, with careful consideration for drug interactions in complex patient cases.

Keywords:
AnticonvulsantsAntidepressive agentsNeuropathic painOpioidsPain, neoplasms

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Area of Science:

  • Pain Medicine
  • Oncology
  • Pharmacology

Background:

  • Cancer pain and non-neoplastic pain can involve peripheral/central sensitization or deafferentation.
  • Clinical signs like allodynia and hyperalgesia offer insights into underlying pain mechanisms.
  • The World Health Organization (WHO) pain ladder guides cancer pain therapy, starting with non-opioid analgesics.

Purpose of the Study:

  • To outline current strategies for managing cancer pain and associated neuropathic components.
  • To highlight the role of non-opioid analgesics, opioids, and co-analgesics in pain management.
  • To emphasize the importance of considering drug interactions and dosage adjustments in specific patient populations.

Main Methods:

  • Review of established pain management guidelines, including the WHO pain ladder.
  • Discussion of pharmacological interventions for cancer pain, including opioids and co-analgesics.
  • Consideration of pain mechanisms (sensitization, deafferentation) and their clinical manifestations.

Main Results:

  • Non-opioid analgesics form the foundation of cancer pain treatment.
  • Opioids are effective for cancer pain, even with neuropathic components (up to 40% of cases).
  • Co-analgesics aid pain control and manage comorbidities like anxiety, depression, and sleep disorders.

Conclusions:

  • Cancer pain management requires a multimodal approach tailored to individual patient needs.
  • Dosage adjustments are crucial for patients with reduced liver or renal function.
  • Pharmacodynamic and pharmacokinetic interactions must be carefully managed in multimorbid or critically ill patients receiving opioids and other psychotropic medications.