Controversies in pharmacotherapy of pain management.
Since the establishment of the WHO three-step ladder for management of cancer pain, several controversies have arisen, which are partly due to new drug development, reformulations of older analgesics, and technological advancements. As a result, clinicians need clarification of several questions. Is morphine the opioid of choice for moderate to severe pain in cancer? Should combinations of opioids be used? When should spinal opioids be used to treat pain in cancer? What are the appropriate opioid doses for breakthrough pain? Should selective cyclo-oxygenase (COX) 2 inhibitors be used? What is the best tactic to treat neuropathic pain, and what first-line adjuvant analgesic should be used? And do bisphosphonates relieve bone pain in cancers other than breast cancer and myeloma? This review addresses these questions.
Davis
Mellar P
MP
Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA. davism6@ccf.org
Walsh
Declan
D
Lagman
Ruth
R
LeGrand
Susan B
SB
D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D001842:Bone and Bones; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D009437:Neuralgia / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
D000700:Analgesics; D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D004164:Diphosphonates