Current approaches to the management of cancer pain: a review

Pain, which is among the most prevalent symptoms experienced by cancer patients, can be effectively treated. Patient assessment, the use of anticancer therapies and systemically administered non-opioid and opioid analgesics are pivotal. Practical aspects of opioid pharmacology include both drug selection, methods of analgesic administration: selection of the appropriate route, dose titration, and an understanding of the management of side effects. Specific approaches for the management of patients unable to attain an acceptable balance between relief and side effects of opioids are described. These comprise non-invasive interventions, including the use of adjuvant analgesics, psychological therapies and physiatric techniques, and invasive interventions, such as the use of intraspinal opioids, neural blockade and neuroablative techniques. Finally, the use of sedation in the management of patients with pain that is refractory to other interventions is addressed. This approach can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine to address these difficult problems.