Just as HIV forever changed the
way we approached every aspect of patient care, the pervasive use of opioids
for chronic non-cancer pain is now altering the way we care for the patient
suffering from acute and chronic pain of malignant origin and has made the care
of this important patient population much more challenging.
It seems that it was but a very
few years ago that the alleviation of pain in cancer patients seemed within our
reach. As clinicians began to understand the nature of cancer pain and how to
treat it, the number
of patients with uncontrolled cancer pain began to decrease. This was
accomplished in large part by the widespread implementation of the World Health
Organization Three Step Therapeutic Ladder.
While the Ladder has been
subsequently modified to add a fourth step to include interventional pain
management modalities and a fifth step to include reversible neuroaugmentation
modalities, the mainstay of the Ladder’s efficacy in the management of cancer
pain remains the rational use of opioid analgesics.
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