Analgesic Ladder

Abstract

Cancer pain relief is an important but neglected public health issue. An analysis of 32 published reviews revealed that 70% of patients (pts) with advanced cancer had pain as a major symptom; and of adults and children undergoing anticancer therapy, up to 50% experience pain. Numerous reports indicate that this pain is not treated adequately. Effective pain management is one of four priorities in a comprehensive World Health Organization (WHO) cancer program, the others being primary prevention, early detection, and treatment of curable cancers. In 1982, WHO brought together a group of experts who prepared a draft of guidelines on the relief of cancer pain that expressed (1) the consensus that, using a limited number of drugs, pain relief was a realistic target for the majority of cancer pts, and (2) the observation that oral opioids, particularly morphine, were of great importance in cancer pain therapy. The present book, which is based on the 1982 guidelines, describes the nature of cancer pain and the reasons for inadequate control of such pain; pain assessment, therapeutic strategy, and continuing care; education and training of health care workers and the public; legislative factors and substance abuse; and organizational aspects, such as health services. (69 Refs)