Role of neuraxial drug delivery in cancer pain therapy

Opioids have long been the mainstay of cancer pain treatment and have been used without any consideration for their effect on cancer growth and long-term prognosis. There is now growing evidence that the continued use of opioids for this indication should be reviewed and even reconsidered. Although current evidence and literature covering this subject is mixed and does not yet allow for a clear determination to be made about safety, there is enough data to support the search for new treatment paradigms, beginning with anesthesia for oncologic surgery and management of cancer pain over the disease course.

Acute Abdomen in a Patient with Cancer Pain on Oxycodone

Opioids are a mainstay of treatment for moderate to severe cancer pain. At present, oxycodone has fewer adverse effects compared to morphine and is widely used for cancer pain therapy. The adverse effects of oxycodone are similar to morphine and include constipation, nausea, and sedation. However, acute abdominal pain is rarely seen. Here, we describe a cancer patient presenting with acute abdomen with stercoral diarrhea. A 54-year-old man with squamous cell carcinoma of the external auditory canal had been taking oxycodone for pain relief. The patient had taken oxycodone for several months and had never complained of either diarrhea or constipation. After an increase in the dosage of oxycodone, he complained of abdominal distension and constipation. After being administered a laxative, he complained of diarrhea and severe abdominal pain. He visited the emergency department and was diagnosed with acute colonic obstruction caused by severe constipation. He self-medicated with oxycodone at dosages of up to 180 mg/day, and this abrupt increase of oxycodone caused stercoral diarrhea. Finally, total blockage of stool developed, resulting in acute abdomen.

Hurdles in successful treatment of cancer pain caused by primary healthcare

Background: The aim of this study is to envisage the hurdles set by physicians in primary healthcare that can cause, or contribute to unsatisfactory cancer pain management. Methods: The study has been carried out as a prospective open non-randomized one (based on a questionnaire). It comprised 283 physicians in primary healthcare from 21 institutions of primary healthcare in Serbia. The choice of physicians was done at random, and the completion of questionnaires was voluntary. The questionnaire comprised 12 questions. Among other issues the questions covered the most important characteristics of the analgesics in their opinion, the individual doses of drugs they most often prescribe, maximum daily doses of these drugs they prescribe (tramadol, fentanyl TD, hydromorphone, methadone, IR morphine); whether they introduce opioids and/or increase the dose autonomously or only upon a specialist?s recommendation; and what is preventing them to successfully treat cancer pain; what side effects they fear and others. Results: Tramadol was favored in the previous year (82.3%), in the last month the physicians prescribed NSAID as therapy in 63.4% of the cases, tramadol was given to 13.60%; fentanyl TD to 13.40%; hydromorphone to 2.7%; IR morphine to 3.80%. Efficiency was marked by 89.80% of physicians as the most important characteristic, tolerability by 82.3%, and duration of effects by 77.4%. Tramadol is most often the choice of therapy in their daily practice although they said it to be less efficient, less tolerable, with shorter analgesic effect, less user friendly, and more expensive compared to fentanyl TD and the other opioids. They said the side effects they fear the most were respiratory depression and sedation. 23.70% of the physicians in the primary healthcare introduce and/or increase the dose of opioids (34.6%) into the therapy autonomously, and 76.30% of them introduce these drugs and/or increase the dose (65.4%) only upon a specialist?s recommendation. Conclusion: Barriers have a great influence on successful treatment of cancer pain. There is a burning need for further education which has to encompass raising awareness of the current guidelines and recommendations in the cancer pain therapy, their acquisition and utilization in everyday practice through interactive workshops with case studies because there is still an alarming lack of knowledge, level of prejudice and apparent opiophobia.