Controversies in the long-term management of analgesic therapy in patients with advanced cancer

Abstract

The management of pain in the patient with advanced cancer requires comprehensive assessment and expertise in the application of many therapeutic techniques.Given the complexity of the problerm posed @ these patients, it is not surprising that most aspects of palliative care derive from personal anecdote and clinical consensus, rather thun welldejned guidelines based on research findings.In the absence of such guidelines, unresolved issues and controversies abound.This review d&u.sses some of the most important of these topics, which range from the overall system of care and quality of assessment to the specifics o~pphu~cotherapr and other modalities of treatment.In so doing, the rationale for sake of the accepted clinical approaches can be clar$ed, others that are as yet little known can be highlighted, and the issues most in need offurther investigution can be defined.J Pain Symptom Manage 1990;5:307-319.Key Words Cancer pain, palliative care, opioid thevafi, morphine _--There is a compelling need for ongoing pain assessment and effective analgesic therapy in patients with cancer.Pain is an extremely prevalent symptom, experienced by 30% to 50% of those in active treatment and 70% to 90% of those with advanced disease.'-"Despite evidencc that most patients can be relieved of pain using readily available techniques, undertreatment i5 common.*-'Undertreatment has been ascribed to numerous factors, including inade-