Reviewer: Jack Wei, MD
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 13 de junio del 2005
Authors: Franco Marinangeli, Alessandra Ciccozzi, Marco Leonardis, et al.
Source: Journal of Pain and Symptom Management 27(5):409-416, 2004
The current article compares two strategies for pain management in patients with terminal cancer. Given that cancer pain has such a profound effect on the QOL in these patients, optimizing pain control should be a priority in their treatment. This study shows that treatment with first-line "strong" opioid results in decreased pain intensity and may have been better tolerated, as evidenced by the lower frequency of therapeutic changes seen in the first-line strong opioid group. Although the WHO ladder for pain management has been shown to be effective, a stepwise approach to pain management may not be the optimal approach to management in this particular group of patients who often have limited life expectancies. In this study, careful titration of strong opioids resulted in improved pain control without significantly worsened toxicity. First-line strong opioids should be considered in all patients with disease-related pain in patients with terminal cancer.
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