Essential Cancer Pharmacology: The Prescribers Guide (Lippincott Williams & Wilkins Handbook)

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In , the World Health Organization WHO established guidelines for pain relief in cancer patients; these guidelines remain the standard of care to this day. Consequently, if a patient reports inadequate pain relief, a provider can determine if the dosing and associated intervals are appropriate. Similarly, the intensity and frequency of pain can be correlated with the WHO ladder to see if the patient is being undertreated. The WHO recommendations are clear and have been implemented with quantifiable success in different clinical settings. When practiced appropriately, the WHO guidelines provide a good foundation for pain relief.

If patients are experiencing neuropathic pain, an existing medication schedule can be supplemented with antidepressants eg, tricyclic antidepressants , anticonvulsants eg, gabapentin, pregabalin , and topical agents eg, lidocaine patch. Medication side effects, fear of addiction, and the development of tolerance can weigh down on patients and make them noncompliant or averse to the pharmacologic pain management. The search then begins for nonpharmacologic ways to cope with pain. A subset of patients with limited metastases have long-term survival following definitive treatment.

More commonly, patients with distant metastases require supportive care and palliative treatment. Interestingly, pain is not necessarily associated with lower survival odds in patients with advanced cancer. Individuals with poor performance status, extensive disease, and inadequate nutrition generally have a worse prognosis and may be better candidates for supportive therapy alone.

For this poor-prognosis cohort, potential side effects of treatment may outweigh any palliative benefit. Interventions geared toward relaxation in cancer patients can also be used to reduce reactivity to pain. The relaxation techniques discussed here involve the use of deep breathing and imagery. On a basic level, consciously pairing muscle tension with inhalation and muscle relaxation with exhalation assists a patient in using breathing to control pain.

Sam Willis, Roger Dalrymple

More specifically, deep breathing is thought to help the patient concentrate better, soothe the nervous system, and balance the mind-body connection—this is especially true when used during activities like yoga, meditation, and tai chi. Jon Kabat-Zinn, PhD, established the mindfulness-based stress reduction MBSR meditation technique that has been studied for its effect on psychological stress and pain in cancer patients.

MBSR is an 8-week, structured program that includes sitting meditation, silent body scanning, and simple yoga postures. Imagery in the context of cancer is defined as having patients use positive visualizations to substitute for the feeling of pain. The actual practice of using imagery involves asking a patient in a relaxed state to think of an image representing pain and then have the patient purposely change this image into a more positive one.

This can be done by cognitively molding or replacing the painful, negative image with a peaceful, happy, or calm mental experience. By using such imagery training, the patient focuses less on pain itself when it happens. Furthermore, the ability to use this technique at will gives patients a sense of power over their pain. A scientific framework exists behind the use of exercise for pain relief in cancer patients, for which both physiological and psychological benefits have been reported. The main objective in using exercise to relieve cancer-related pain is to resolve the physical inactivity that often accompanies the diagnosis.

With immobility comes muscle wasting and weakness, changes in affect, decreased self-reliance, and reduced coping skills. It is important for a patient with a confirmed diagnosis of cancer, however, to undergo necessary health and fitness assessments before being prescribed an exercise regimen. This includes a review of recent EKGs, imaging studies, cardiovascular exams, feeding habits, current medications, and baseline laboratory results.

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Generating temporary muscle tension through exercise prevents muscle atrophy and increases muscle mass. On a similar note, techniques from osteopathic manipulative medicine OMM , such as soft-tissue mobilization, myofascial release, connective-tissue stretches, and joint articulation can be used to manage pain.

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The mode, frequency, intensity, and duration of the exercises should be adjusted over time based on the health status, needs, and goals of the individual patient. A patient can begin exercise therapy under the supervision of many practitioners, including cancer-pain specialists, personal trainers, physical therapists, nurses, and primary-care providers.

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Exercise results in increased endurance, improved functional capacity, enhanced well-being and body image, and decreased emotional distress caused by anxiety, depression and fatigue; all of these factors effectively contribute to the reduction in pain. The fight against cancer-related pain should be a multidisciplinary team approach.

Physicians, counselors, therapists, mental-health professionals, trainers, families, and of course, patients themselves, should work together to create an ideal pain- management plan. Cancer patients with uncontrolled pain have a greater risk of suicide, which highlights the importance of timely intervention. Subscribe to PPM. Sign-up now! Types of Pain Acute Pain. Cancer Pain. Neuropathic Pain. Oral and Maxillofacial Pain. Rheumatologic and Myofascial Pain. Spine Pain. Other Types of Pain. Addiction Medicine. Complementary Treatments. Interventional Pain Management.

Manipulation and Massage. Chronic pain sufferers are using our pain specialist directory to find pain specialists in your area.

Managing Cancer-Related Pain: A Look at Alternative Approaches

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Anxiety and Pain. Central Pain in Rheumatoid Arthritis. Painful Genetic Diseases. Responding to Women's Pain Early and Effectively. Nonpharmacologic cancer-pain management has advanced beyond palliative care, showing significant evidence of benefit and potential for pain relief and improved quality of life.

Portenoy RK. Treatment of cancer pain. Archived from the original on 14 September The Journal of Toxicological Sciences. Bentham Science Publishers.

Essential Cancer Pharmacology: The Prescriber's Guide

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Thomson PDR. Pharmacology for Nursing Care. European Urology. Journal of Clinical Oncology. Bicalutamide is a new antiandrogen that offers the convenience of once-daily administration, demonstrated activity in prostate cancer, and an excellent safety profile. Because it is effective and offers better tolerability than flutamide, bicalutamide represents a valid first choice for antiandrogen therapy in combination with castration for the treatment of patients with advanced prostate cancer. Advanced Therapy of Prostate Disease. Archived from the original on 10 June BJU Int.

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