title: Advantages of an etiology-based method for treating cancer pain: a case report and literature review.
abstract: The WHO analgesic guidelines for treatment of cancer pain have been proven safe and effective for most patients. However, there is still inadequate analgesia following that guideline based on pain degree.
  
  
  METHODS
  An 82-year-old man with history of right ceruminous gland carcinoma was treated by tumor resection following numerous courses of chemotherapy. He developed progressive pain ranging from 4 to 8 or 9 on the 0-10 numeric rating scale (NRS) involving the right side of face and neck area. Based on the WHO analgesic ladder, the primary prescription for the man contained tramal (100 mg/d) and celebrex (400 mg/d). However, pain relief was unsatisfied with this prescription even when dose of tramal increased to 200 mg/d. Then, tramal was replaced with morphine sulfate tablets at 15 mg at every 8 hours, but the pain was only modest relieved. After revaluation by pain physicianbased on etiology and mechanism of pain using ID pain questionnaire, the patient was identified to experiencing neuropathic pain. Finally, the pain was successfully relieved by gabapentin as an adjuvant to tramal.
  
  
  CONCLUSIONS
  The successful pain relief of the patient in this case indicates that treatment of pain that based on mechanism might be worth promoting. According to the etiology of pain, specific drugs or measures should be selected for the individual patient. This approach have certain advantages, such as timely pain relief, reduction of medical cost, and effective improvement of life quality of cancer patients.
authors.affiliation: Department of Anesthesiology, West China Hospital of Sichuan University Chengdu 610041, Sichuan, P. R. China.
authors.forename: Xiaojia
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, West China Hospital of Sichuan University Chengdu 610041, Sichuan, P. R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, West China Hospital of Sichuan University Chengdu 610041, Sichuan, P. R. China.
authors.forename: Bangxiang
authors.initials: B
authors.lastname: Yang
keywords: Cancer pain; WHO analgesic ladder; adjuvants; neuropathic cancer pain