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Pain Management
written and compiled by doctordee
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Pain Management

For management of chronic pain in cancer patients there are pain clinics that have teams of people, usually containing at least a psychologist and an anesthesiologist. There are also doctors who are skilled in managing pain, and limit their practice to it.

Pain clinics generally use a combination of:

1. Non Steroidal Anti Inflammatory Drugs [NSAIDs]
These are called antiinflammatories -- they can be ibuprofen, naproxen, diclofenac, or others. They can be given as pills with meals, IM injection, or as suppositories.

2. Antidepressants
Antidepressants raise the pain threshold, and are given for that reason in people with chronic pain, and not necessarily because a person may be clinically depressed.

3. Psychological Techniques
Specific psychological techniques for pain management, as well as relaxation exercises, hypnotherapy, acupuncture, visualization, massage, and possibly other modalities, are useful for addtional control over pain.

4. Opiates
Opiates are given as a stable dose, with additional doses as a backup for breakthrough pain. Opiates are usually given by mouth, injection, and/or patch.

5. Bisphosphonates and/or Radiotherapy for Bone Pain
For cancer patients, bone pain is perhaps the most tedious pain to manage. In addition to the above combinations, Bisphosphonates and/or Radiotherapy can be used to help control bone pain.
Resources & Information

NCCN Cancer Pain Treatment Guidelines for Patients Download .pdf file

MD Anderson Cancer Center Pain Management

Cancer Pain Treatments , Caregivers Guide, Physician's Guide

What's New in Cancer Pain Treatment

Strategies for the treatment of cancer pain in the new millennium

Living With Chronic Pain

"Chronic pain following cancer is a distinct disease entity
and the patients present a unique challenge in terms of their pain management. Because of their cancer diagnosis, there has been a long tradition of treating them as patients in whom opioid use and dose escalation are always justifiable, yet they have long-term survivals and can be susceptible to all the pitfalls of long-term opioid treatment. This article reviews the principles of chronic opioid treatment and their relevance to the treatment of chronic pain following cancer."
Chronic Pain Following Treatment for Cancer: The Role of Opioids

Management of opioid side effects in cancer-related and chronic noncancer pain: A systematic review

Pharmacologic Management of Breakthrough or Incident Pain

Managing Neuropathic Pain: New Approaches for Today's Clinical Practice

January 2004

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