Effective Use of Narcotic Analgesics

Abstract

Pain occurs in about 2/3 of patients with far-advanced cancer. It is not always caused by the neoplasm itself; an important fact when considering the place of narcotic analgesics in cancer pain management. Further, some cancer induced pains are more responsive to narcotics than others. For example, in metastatic bone pain a local high concentration of prostaglandins “sensitizes” the nerve endings and, pharmacologically, the best result is usually obtained by the combined use of a prostaglandin synthetase inhibitor (aspirin, etc.) and a centrally acting narcotic. The site of the neurological lesion, and the type of pain, also determine how effective narcotics will be (Table 1). These factors are responsible for the evolving science of “co-analgesics”.