Perspectives

Cancer pain management: what are the controversies?

Perspectives

Cancer pain management: what are the controversies?

Taylan Gurgenci, Phillip Good, Janet R. Hardy

Figures

© KATARZYNABIALASIEWICZ/               ISTOCKPHOTO.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© KATARZYNABIALASIEWICZ/ ISTOCKPHOTO.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

Adequate pain relief in people with advanced cancer can usually be achieved using an evidence-based, multidisciplinary approach. However, some patients experience refractory cancer pain, with clinicians then understandably turning to controversial therapeutic options. This article considers some of these therapeutic options and the evidence supporting or cautioning against their use.

Key Points

  • The benefit of the World Health Organization analgesic ladder in facilitating pain relief in patients with cancer outweighs the criticisms.
  • The prescription of opioid analgesia should be individualised to the needs and preferences of patients.
  • Methadone can be a useful drug in refractory cancer pain but is best left to specialists in view of the potential for harm.
  • The use of ketamine for chronic cancer pain is not supported by the existing evidence.
  • Given the lack of high-quality evidence of clinical benefit, it is hard to recommend medicinal cannabis as standard practice for cancer pain management.