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14 - Adjuvant analgesic drugs
- from SECTION IV - PHARMACOLOGICAL TREATMENT
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- By RUSSELL K. PORTENOY, Beth Israel Medical Center and Albert Einstein College of Medicine, MERVYN KOH, Tan Tock Seng Hospital
- Edited by Eduardo D. Bruera, University of Texas, Houston, Russell K. Portenoy, Albert Einstein College of Medicine, New York
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- Book:
- Cancer Pain
- Published online:
- 06 July 2010
- Print publication:
- 12 October 2009, pp 272-286
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Summary
Introduction
The term adjuvant analgesic was originally coined to refer to a small number of drugs that were commercialized for reasons other than pain but could be used as analgesics in selected circumstances. When these nontraditional analgesics were prescribed to cancer patients to supplement the analgesia provided by opioids, they were considered to be adjuvant to the mainstay therapy – hence the term. In recent years, the number, diversity, and conventional use of these nontraditional analgesics have increased dramatically. Several are now indicated and promoted for specific types of noncancer pain and many are used as first-line therapies in varied populations. Accordingly, the term adjuvant analgesic is now a commonly applied misnomer and refers to a large and diverse group of drugs that have an expanding role in pain medicine.
In the management of cancer pain, the term adjuvant analgesic also must be distinguished from other labels, specifically adjuvant drug and co-analgesic. According to the three-step analgesic ladder model of cancer pain pharmacotherapy developed under the auspices of the World Health Organization in the mid-1980s, adjuvant drugs comprise both analgesics used to supplement opioid therapy (adjuvant analgesics) and drugs used to manage the side effects of the opioids. Given this dual labeling, the drugs intended to provide analgesia are best denoted by the more specific term adjuvant analgesics. The label co-analgesic has been used synonymously with adjuvant analgesic in the cancer treatment setting and also could be used whenever referring to a drug added for analgesic purposes to an existing opioid regimen.
4 - Cancer pain syndromes
- from SECTION II - EPIDEMIOLOGY AND SYNDROMES
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- By MERVYN KOH, Tan Tock Seng Hospital, RUSSELL K. PORTENOY, Beth Israel Medical Center and Albert Einstein College of Medicine
- Edited by Eduardo D. Bruera, University of Texas, Houston, Russell K. Portenoy, Albert Einstein College of Medicine, New York
-
- Book:
- Cancer Pain
- Published online:
- 06 July 2010
- Print publication:
- 12 October 2009, pp 53-86
-
- Chapter
- Export citation
-
Summary
Introduction
The reported prevalence of cancer pain varies across studies and is highly influenced by the population evaluated, stage of disease, and treatment setting. The overall prevalence is between 33% and 50% and is considerably higher – above 70%–among those with advanced disease.
Chronic pain adversely affects all domains of quality of life, including physical functioning and well-being, mood and coping, and social interactions. Pain may be a focus on problematic communication with health professionals or contribute to distress through its association with disease progression or recurrence. Although not an independent predictor of poor prognosis, uncontrolled pain has been linked to suicidal ideation.
Although pain is widely regarded to be a significant problem in oncology, management continues to be compromised by under-recognition and undertreatment. Good pain control may reduce hospitalizations, physician and emergency room visits, and overall health care costs, and should be considered a best practice in cancer care. Effective control of pain and other symptoms is the foundation for the array of psychological and spiritual processes that together assist the patient in coping with the rigors of the disease and its treatment. The latter processes, in turn, may contribute to symptom relief, an observation underscored by the diversity of effective nonpharmacological approaches to pain treatment.
Pain assessment and classification
Given the high prevalence of cancer pain and its potential for profound adverse consequences, all patients with active disease should be routinely screened for pain.