title: Pain management of the cancer patient.
abstract: BACKGROUND
  Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain.
  
  
  METHODS
  The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended.
  
  
  CONCLUSIONS
  There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines.
authors.affiliation: Professor, Chair of Anaesthesiology, The University of Western Australia, School of Medicine and Pharmacology, Pharmacology, Pharmacy and Anaesthesiology Unit , Perth , Australia.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Schug
authors.forename: Chandani
authors.initials: C
authors.lastname: Chandrasena
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000188:drug therapy / Q000503:physiopathology; D002908:Chronic Disease; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology; D009437:Neuralgia / Q000188:drug therapy / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D014944:World Health Organization
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid
keywords: WHO guidelines; cancer pain; co-analgesics; non-opioids; opioids