Anesthetic techniques for the management of cancer pain

Article Abstract:

Since their introduction in the late 1930s, anesthetic techniques using neurolytic agents have become standard for managing cancer-related pain. In spite of their effectiveness, neurolytic agents used in conjunction with anesthetic techniques are not able to eliminate all cancer-related pain. A common pain-management strategy is a "progressive ladder" approach involving four stages. In the first stage, oral analgesics are administered; by the fourth stage the patient is receiving continuous intravenous infusion of narcotics to relieve pain. If prior stages are successful in managing pain, fourth stage techniques are unnecessary. Pain control must involve the cancer patient and his or her family, and must include discussion about the diagnostic and therapeutic use of medications and procedures, citing risks and obtaining appropriate consent. Use of surgical techniques to reduce pain are appropriate when other methods fail. There are two major anesthetic surgical approaches anesthetic for cancer-related pain: nondestructive procedures that block nerve transmission by infusing opioids into the spinal canal (intrathecally), and destructive procedures requiring injection of agents and insertion of freezing probes into nerves to destroy their activity, eliminating the routes by which pain signals are transmitted. Destructive and nondestructive neurolytic techniques for blocking pain must be chosen in order to target the appropriate pain sites in the body.

Management, Informed consent (Medical law), Informed consent, Drug targeting, Problem families, Dysfunctional families, Anesthetics

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Neurosurgery in the treatment of cancer pain

Article Abstract:

Greater understanding of the causes of cancer-related pain has been achieved through the effective use of radiologic diagnostic methods. Diagnostic methods are capable of exposing the sites of cancer-related pain (e.g., spinal cord compression due to a tumor) and allow physicians to control pain, either through the use of analgesics, such as opioids (non-opium-derived synthetic narcotics), or by neurosurgical procedures (e.g. to disrupt pain pathways in the nervous system). Neurosurgery to relieve cancer-related pain should be considered when the use of systemic opioids has failed to achieve adequate pain control. The major advantage of a neurosurgical procedure is the freedom from side effects, such as excessive drowsiness and lethargy, often associated with oral opioid therapy. Surgical procedures for pain relief can be divided into three main categories: neuropharmacological delivery systems, that allow direct delivery of opioid pain-relief agents to the pain site in the central nervous system; neuroblative procedures, which interrupt pain transmission fibers to the site of the cancer lesion; and neurostimulatory procedures, in which electrodes are implanted for the electrical stimulation of nerves.

Analysis, Usage, Surgery, Nervous system, Dosage and administration, Diagnosis, Radioscopic, Radioscopic diagnosis, Autonomic drugs, Autonomic nervous system agents, Neurosurgery

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Controlled-release morphine (MST Contin) in advanced cancer: the European experience

Article Abstract:

Administration of opioid substances is an important means of controlling moderate to severe cancer-related pain. Opioids such as controlled-release oral morphine sulfate (Morphine Sulphate Contin tablets, MST) have proven to be more effective and convenient than standard oral morphine, which is usually administered every four hours. MST Contin is a long-acting oral form of morphine that is able to control cancer-related pain continuously for 12 hours. The proper and effective use of MST is based on the determination of a patient's dose requirements. Researchers in the United Kingdom suggest that MST administration should be instituted after dose stabilization has been achieved using an immediate-release morphine preparation, the so-called "standard" oral morphine. Evidence from the U.K. study demonstrates that for the majority of patients suffering from cancer-related pain, twice-daily administration of MST provides satisfactory pain relief. The results of the study also indicate that the relative potency and side effects of MST, compared to standard oral formulations of morphine, appear to be the same.

Research, Complications and side effects, Opioids, Analgesia, Morphine, Great Britain

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