Managing pain in a patient with pancreatic cancer (2) pancreatic cancer (2)

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
The information aims to provide educational purpose only. Anyone reading it should consult Oncologist before considering treatment and should not rely on the information above