Cancer pain: part 2: physical, interventional and complimentary therapies; management in the community; acute, treatment-related and complex cancer pain: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners.
OBJECTIVE
This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain.


METHODS
This document has been produced by a consensus group of relevant healthcare professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the second of two parts, physical, invasive and complementary cancer pain therapies; treatment in the community; acute, treatment-related and complex cancer pain are considered.


CONCLUSIONS
It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.
Raphael
Jon
J
Faculty of Health, Birmingham City University, Birmingham, UK. jon.raphael@bcu.ac.uk
Hester
Joan
J
Ahmedzai
Sam
S
Barrie
Janette
J
Farqhuar-Smith
Paul
P
Williams
John
J
Urch
Catherine
C
Bennett
Michael I
MI
Robb
Karen
K
Simpson
Brian
B
Pittler
Max
M
Wider
Barbara
B
Ewer-Smith
Charlie
C
DeCourcy
James
J
Young
Ann
A
Liossi
Christina
C
McCullough
Renee
R
Rajapakse
Dilini
D
Johnson
Martin
M
Duarte
Rui
R
Sparkes
Elizabeth
E
D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D017028:Caregivers; D002648:Child; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D059408:Pain Management; D010166:Palliative Care; D010821:Physicians, Family; D012952:Societies; D016896:Treatment Outcome; D006113:United Kingdom
D000700:Analgesics