[Therapeutic strategy in cancer pain]

Surgical and pharmacological management of cancer pain is described and discussed according to the physiopathological mechanisms underlying this complex syndrome. The therapeutic approach is planned in three mayor phases which may be employed alone or in combination, following an accurate evaluation of the pathophysiology and the clinical pattern in every single patient. The first phase includes multifocal pharmacological therapy by nonnarcotic drugs in order to affect at different levels the physiopathological mechanisms of cancer pain. The second phase is indicated when nonnarcotic drugs cannot achieve complete pain relief; neurosurgical procedures (nerve blocks, rhizotomies, cordotomies, ecc...) are employed in this phase. The pharmacological treatment must be continued and associated to surgery. The third phase includes hypophysectomy, deep brain stimulation, psychosurgery and/or narcotic drug therapy, which are the last step in management of terminal cancer pain when all treatments have been ineffective. The results of this therapeutic program in 188 patients affected by pain of malignant origin are reported and discussed.