by Ben Tang

Created on: June 22, 2009   Last Updated: July 01, 2009

As high as 70% of cancer patients experience chronic pain and about 50% of these patients report moderate to severe pain. Despite these alarming figures, many cancer patients are not treated sufficiently despite effective pain control drug.

The reason for under-treatment include the fear of opioid ( morphine) addiction by physician or caregiver, treatment with anti anxiety drugs instead of pain drugs due to perception of anxiety pain, under reporting of pain by patients to physician and difficulty of access to medication due to high cost.

WORLD HEALTH ORGANISATION (WHO) GUIDE

WHO recommends the 3- Step approach to managing pain. The first step is using non-opioid drug such as acetaminophen (Tylenol) and Non Steroid Anti Inflammatory (NSAID) Drugs such as aspirin, diclofenac (Voltaren). The 2nd step in the guide is the addition of opioid. Opioids are derivatives of opium and they act in the pain receptors of the central nervous system to stop pain. Generally, opioids are classified into 2 category; short acting and long acting.

Short acting opioids work for a shorter duration and therefore used as a required basis instead for chronic pain. Examples of these drugs are codeine, hydrocodone, oxycodone, and oxymorphone.

Long acting opioids such as fentanyl, methadone and morphine offer pain relief for a longer duration of time (up to 8 hours). Many drug manufacturers alter the short acting opioids to provide a long acting action. These drugs are classified as long acting preparation and commonly called controlled / extended / sustained release. For example, Oxycontin CR stands for controlled release version of a short acting oxycodone.

The final step ( 3rd step) in the WHO guide is Freedom From Cancer Pain. By utilizing all available medication, the role of the treating physician is to find the optimum treatment plan to free the patient from pain. The recommended strategy is to give a long acting opioid or a long acting preparation for chronic, severe pain like cancer. Short acting opioid is reserve only for any breakthrough pain.

FACTS ABOUT OPIOID

Medical literature has debunked some myths about opioids. Opioids do not vary in efficacy. Differences lie in the side effects. Some patient may experience more nausea with morphine but may not have the same effects with hydromorphone. There is no maximum dose for a patient. Individual patients have difference tolerance level. Therefore, it is important to keep track of the drug usage, so that the physician

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