Clinical case discussion: treating severe pain syndrome with strong opioids in combination with nsaids in a cancer patient
https://doi.org/10.21518/2079-701X-2018-19-113-115
Abstract
Approaches to treating pain in cancer patients are individual in each case. However, there are general principals. Most often, physicians encounter difficulties when transfer patients from tramadol to more potent tertiary preparations of WHO Analgesic Ladder. The administration and titration of strong opioids to a dose that will ensure adequate pain control with minimal side effects is not an easy task. Here, the physician focuses on the pathogenesis of pain and takes into account the tolerability of drugs prescribed. Individual selection of adjuvants that can affect the cause of pain can reduce the rate of strong opioid dose escalation their side effects. However, what to do, if the use of effective adjuvants is limited? The article provides the discussion of these issues.
About the Authors
R. R. SarmanaevaRussian Federation
G. R. Abuzarova
Russian Federation
References
1. Mishra S., Bhatnagar S., Gupta D. et al. Management of neiropatic cancer pain following WHO analgesic ladder: A prospective study. Am J Hosp Palliat Med, 2009, 26(6): 447-51.
2. Zech D.F., Grond S., Lynch J. et al. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain, 1995, 63: 65–76.
3. McNicol E., Strassels S.A., Goudas L. et al. NSAIDS or paracetamol, alone or combined with opioids, for cancer pain. Cochrane Database Syst Rev, 2005, 1: CD005180.
4. Nabal M., Librada S., Redondo M.J. et al. The role of paracetamol and nonsteroidal antiinflammatory drugs in addition to WHO Step III opioids in the control of pain in advanced cancer: A systematic review of the literature. Palliat Med, 2012, 26: 305-312.
5. Duarte J.F. Souza, Lajolo P.P., Pinczowski H. et al. Adjunct dipyrone in association with oral morphine for cancer-related pain: The sooner the better Support. Care Cancer, 2007, 15: 1319- 1323.
6. Ferrer-Brechner T., Ganz P. Combination therapy with ibuprofen and methadone for chronic cancer pain Am J Med, 1984, 77: 78–83.
7. Weingart W.A., Sorkness C.A., Earhart R.H. Analgesia with oral narcotics and added ibuprofen in cancer patients. Clin Pharm, 1985, 4: 53-58.
8. Mercadante S., Fulfaro F., Casuccio A. A randomised controlled study on the use of anti-inflammatory drugs in patients with cancer pain on morphine therapy: Effects on dose-escalation and a pharmacoeconomic analysis. Eur J Cancer, 2002, 38: 1358-1363.
9. Camu F., Vanlersberghe C. Pharmacology of systemic analgesics. Best Pract Res Clin Anaesthesiol, 2002, 16: 475-488.
10. Colvin L., Fallon M. Challenges in cancer pain management-bone pain. Eur J Cancer, 2008 May, 44(8): 1083-90. Epub 2008 Apr 23.
Review
For citations:
Sarmanaeva RR, Abuzarova GR. Clinical case discussion: treating severe pain syndrome with strong opioids in combination with nsaids in a cancer patient. Meditsinskiy sovet = Medical Council. 2018;(19):113-115. (In Russ.) https://doi.org/10.21518/2079-701X-2018-19-113-115