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The range of treatments for pain due to cancer 

The range of treatments for pain due to cancer
The range of treatments for pain due to cancer

Peter Hoskin

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date: 27 January 2021

Cancer pain will comprise a complex clinical picture often including a number of individual pains each with a somatic source and a variable but significant affective component requiring careful detailed assessment for each patient. The mainstay of management will be analgesics used according to the principles of the analgesic ladder but these should be augmented by appropriate adjuvant drugs such as non-steroidals, anxiolytics and antidepressants and for neuropathic pain, in particular, antidepressants and anticonvulsants. Non-drug treatments including acupuncture, transcutaneous electrical nerve stimulation (TENS), massage and supportive psychotherapy may have a major role in selected patients. Whenever possible specific anticancer treatment should be considered to address the underlying cause of the pain. Knowledge of the primary tumour and details of previous treatment will inform options for systemic treatment with chemotherapy or hormone manipulation.

Radiotherapy has a major role in the management of bone metastases, cerebral metastases and pain due to progressive local tumour infiltration. Surgery for pathological fracture, vertebral collapse and bowel obstruction, and stenting for oesophageal, bronchial, ureteric and superior vena cava obstruction should also be considered.

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