Discussion
Pain is one of the most common symptoms
experienced by cancer patients. It has been estimated that approximately 50 to
70 percent of patients with cancer experience some degree of pain, which
usually progresses and intensifies as the disease progresses.¹ One study noted
that the incidence of pain in patients with advanced stages of invasive cancer
may be as high as 80 percent. The incidence can be as high as 90 percent for
those with metastases in osseous structures.² However, more than half of cancer
patients have insufficient pain control. Severe pain can significantly impair
patients’ quality of life and interfere with their physical rehabilitation,
nutrition and mobility. Furthermore, a large number of cancer patients suffer
from depression.³
Several practice guidelines on pain control
have been formulated. The most widely used algorithm in the management of
cancer pain is probably the one formulated by the WHO, called the WHO cancer
pain treatment step ladder. These guidelines recommend the use of paracetamol
or NSAIDs as an initial step in pain management, followed by opioid analgesic
for mild to moderate pain, and strong opioids for moderate to severe pain.⁴ (Figure 2) However, some experts
have stated that the WHO guidelines may be inadequate to address current needs
and suggested the addition of a fourth interventional step in the form of nerve
blocks, intrathecal delivery systems, or surgical procedures.⁵
Oxycodone is a synthetic opioid
metabolized to its active metabolite, oxymorphone, in the liver. A comparison
of oxycodone CR and morphine demonstrated similar analgesic effects between the
two drugs. However, there were significant differences in pain control for
patients with underlying renal or hepatic impairment receiving oxyvodone.⁶
although oxycodone is generally more expensive than morphine, it has proven
efficacy in treating moderate to severe pain, and its CR formulation allows for
the convenience of 12-hour dosing intervals.⁷
The use of opioids, though often
perceived to be associated with palliative care, plays and important role in
pain management. In the case of our patient, it resulted in satisfactory pain
control and improved quality of life, enabling him to undergo and tolerate
subsequent chemotherapy, which can potentially control the disease and prolong
survival.
Dr Leung-Cho
Chan
Specialist in Clinical Oncology Private
practice Hong Kong
Reference information: oncologytribune
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