Pain Management in Cancer Patients: A Review - Pakistan ...

292 Wasam Liaqat Tarar et alpain-relieving procedures. Both cancer therapy andtherapy can hinder pain therapy by exacerbatingpain or implicating other adverse effects. On theother hand it can be of help to pain therapy byreducing the proliferation of cancer, lending handas co-analgesic, and by providing route for IVadministration of drugs according to patients needs.Likewise pain therapy can improve cancer therapyby the performance status of patient and surgicallyperformed interventions can help improve organfunction [18].3.6. Use of Multiple OpioidsNo single opioid is completely safe. As drugs areonly tools, it depends on our expertise how we usethem to get the desired therapeutic outcomes. Doseescalation with many co-administered opioids leadsto adequate pain relief along with many unwantedside effects in cancer patients with pain. Drugswitching from one opioid to another is found to behelpful with no considerable correlation among thegenetics and opioid response [19].3.7. Morphine vs. OxycodoneWhen intravenous dosing of two drugs i.e., morphineand oxycodone is compared, it is found that equalanalgesic effect is achieved from both drugs. Theirbioavailability is pretty much similar, only a littlehigher for oxycodone hydrochloride. The patientsIV dose for oxycodone hydrochloride to producesame amount of analgesia as morphine is 30%higher. Nausea and hallucinations are the drawbacksof morphine use. Otherwise both morphine andoxycodone are similar in their actions and there is [20].3.8. Spinal Administration of OpioidsThe spinal administration of opioids may provideanalgesia for longer duration to patients sufferingfrom bilateral or midline lower abdominal or pelviccancer pain. However, there are certain reasonswhich make the use of spinally administeredanalgesics obscure. Cross-tolerance to orallyand parenterally administered narcotics is of to spinal narcotics has also markedly limited theirusefulness. Opioids extensively distribute in theCSF and plasma when administered through theepidural or intrathecal route. The drug reaching tobrain stem sites may account for many of the toxicand therapeutic effects of spinal opioids [21].3.9. Use of BenzodiazepinesBenzodiazepines can be used to indirectly managecancer pain and have been found effective. It isrelated to their psychotropic effects includingreduction of anxiety and depression in manyinstances. Benzodiazepines can serve the purposefor treating chronic pain, acute muscle spasm andassociated anxiety, and neuropathic pain. Alprazolamand clonazepam have been found to be drugs ofchoice. They should not be always considered as with potential harmful effects sometimes such asphysical and psychological dependence, cognitiveimpairment, worsening depression, overdose, andmany other side effects [22].4. BARRIERS TO CANCER PAINMANAGEMENTThe various obstacles including behaviours whichprevent successful management of pain are referredfear of addiction and tolerance of analgesics, poorassessment of pain, communication barrier amonghealthcare professionals and patients and somereligious and cultural norms which all cumulativelylead to poor pain control. [23] [24] Reluctance ofpatients to report pain and utilization of analgesicsstand at the top of the list. The patients are concernedabout the addiction causing factor of analgesicsand their side effects. There is also a wrong notionin patient’s minds that pain is part and parcel ofcancer and ‘good patients do not whine about pain’.It should be eradicated from patient’s minds. A educated and patients belonging to lower incomegroup have these sorts of concerns. Higher painintensity and under treatment of pain leads to moreconcerns. [25] Other barriers included in effectivepain management are poor assessment of pain,physicians are reluctant to prescribe opioids andperceived excessive regulation. The barriers and