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Drugs

, Volume 61, Issue 7, pp 955–977 | Cite as

Strategies for the Treatment of Cancer Pain in the New Millennium

  • Carla Ripamonti
  • E. Duke Dickerson
Review Article

Abstract

As was the case in the era before us, in the new millennium we will continue to see an abundance of patients experiencing cancer-related pain for different reasons. Although much needless pain and suffering still affects many of those with cancer, we are presented with a medical dichotomy. With the analgesic drugs available today, and the relatively simple and effective guidelines to treat cancer pain published and disseminated by the World Health Organization, why do people with cancer continue to experience pain?

As we search for the answer, the horizon may hold promising new drugs, ‘old drugs’ with new interest and applications, and new strategies for the field of pain therapy. Possibilities include the isolation and development of analgesics or analgesic combinations that may minimise the adverse effects which are often associated with the current therapeutic class of opioid analgesics. In addition, current research points to promising results identifying the N-methyl D-aspartate non-opioid receptor as a likely component of neuropathic pain.

Drugs such as gabapentin, the mechanism of action of which is not well known, have found favour within the clinical community for their analgesic properties and good tolerability. Methadone, in a phase of resurgence, has garnered the attention of the clinical community because of its unique receptor activity and pharmacoeconomic benefits. A number of clinical studies have demonstrated that methadone has a valuable role in treating cancer pain. Perhaps, an unbalanced focus on the risks of inappropriate use, rather than the benefits, should not compromise or distract from the use of methadone as an alternative to morphine. Studies are on going to assess the potential role of methadone in treating neuropathic pain. Drugs such as cannabinoids, although currently applicable for patients with anorexia, nausea and/or vomiting, may offer benefits to patients experiencing pain. Other opportunities exist with such compounds as (X2-adrenergic agonists, nicotine, lidocaine and ketamine.

New strategies such as the switching opioids and/or their route of administration may offer improved analgesia with fewer adverse effects, thus providing therapeutic alternatives for the clinical community. In addition, there is interest in the co-administration of opioids that act on different receptors. For instance, oxycodone appears to be a κ opioid receptor agonist and may offer enhanced analgesia when combined with morphine.

Keywords

Morphine Neuropathic Pain Clonidine Gabapentin Naltrexone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The Fellowship at the Oxford International Centre for Palliative Care held by ED Dickerson is funded by Boehringer Ingelheim, Ingelheim, Germany.

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Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Rehabilitation & Palliative Care DivisionNational Cancer Institute of MilanMilanoItaly
  2. 2.Oxford International Centre for Palliative CareOxfordEngland
  3. 3.Ohio Pain InititativeColumbusUSA

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