[Cancer pain.].
There is no uniform etiology of cancer pain. It is essential to understand the pathogenesis of pain as far as possible before a therapeutic modality can be conceived. The anatomical relation of the painproducing lesion to the site of pain perception should be clear (local, projected and referred pain). The origin of cancer-induced pain is classified as follows: malignant, mostly metastatic bone lesions, compression and infiltration of peripheral nerval structures, expansion in limited spaces, distension of liver, obstruction of blood vessels, obstruction and distension of the intestine, other abdominal or thoracic processes that produce visceral pain, infiltration and ulceration of soft tissue in sensitive areas. There are also pain syndromes caused by cancer therapy: post-operative, post-radiation and post-chemotherapy pain. Attention is drawn to the difficulties of pain recording and pain measurement. Psychological and social aspects of cancer patients emphasize the importance of a sufficient pain therapy which is divided into non-drug therapy and drug therapy. Various specialities can contribute therapeutic modalities for the treatment of cancer pain. Surgery, orthopedics, neurosurgery, radiotherapy and others have their specific methods. Anesthesiological methods are mentioned in more detail. The celiac plexus block with alcohol as a simple, safe and efficious procedure should become available to any patient with upper abdominal visceral tumor pain. Attention is drawn to the hospice movement, which is more or less unknown in central Europe. Psychological aspects of cancer patient care are considered. Drug therapy is of greater importance than all other methods. That is the domain of the general practitioner. Commonly used analgesic antipyretics and NSAIDs are listed in Table 1. The principles of opioid therapy follow. Due consideration is given to neuroleptics and antidepressive drugs. Information about hormones (corticosteroids, calcitonin a. o.) in cancer pain therapy conclude this survey. Enormous differences of morphine use (Austria: 0.66 kg vs Denmark 16.59 kg per million people per year) indicate that there is a great demand for further professional education in this field.
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Klinik für Anästhesie und allgemeine Intensivmedizin der Universität, Spitalgasse 23, A-1090, Wien.