Cancer pain: part 1: Pathophysiology; oncological, pharmacological, and psychological treatments: 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 health care professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the first of two parts, pathophysiology, oncological, pharmacological, and psychological treatment are considered.


CONCLUSIONS
It is recognized that the World Health Organization (WHO) analgesic ladder, while providing relief of cancer pain towards the end of life for many sufferers worldwide, 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
Ahmedzai
Sam
S
Hester
Joan
J
Urch
Catherine
C
Barrie
Janette
J
Williams
John
J
Farquhar-Smith
Paul
P
Fallon
Marie
M
Hoskin
Peter
P
Robb
Karen
K
Bennett
Michael I
MI
Haines
Rebecca
R
Johnson
Martin
M
Bhaskar
Arun
A
Chong
Sam
S
Duarte
Rui
R
Sparkes
Elizabeth
E
D000700:Analgesics / Q000627:therapeutic use*; D000818:Animals; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D009434:Neural Pathways / Q000033:anatomy & histology / Q000502:physiology; D009474:Neurons / Q000166:cytology / Q000378:metabolism; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010166:Palliative Care; D010821:Physicians, Family; D051381:Rats; D013116:Spinal Cord / Q000033:anatomy & histology / Q000502:physiology; D006113:United Kingdom; D014944:World Health Organization
D000700:Analgesics