Painformation: ALLEVIATING CANCER PAIN
December 14, 2001 | 12:00am
Cancer is still the No. 4 killer in the country, with breast cancer as the most common form among women. Worldwide, cancer is responsible for 6 million deaths annually. Ten million new cases are reported yearly. Although more predominant in developed countries, the incidence of cancer in developing countries like the Philippines is fast growing.
Cancer is described as the wild, uncontrolled, and abnormal growth of body cells. It can occur in any tissue or organ in any part of the body. If it occurs in the superficial part of the body, it can be more easily detected and treated. If it occurs deep within the body, often symptoms appear only in the later stages of the disease, making treatment more difficult. With early detection and modern methods, many cancers can be treated/.
However, those cases in the later stages of cancer can be a very painful ordeal. For this reason, national cancer control programmes have made the management of pain and other symptoms their primary aim. Tragically, cancer pain is often left untreated, if ever, treatment may be inadequate. The World Health Organization (WHO) has determined that inadequate management of cancer pain is a serious health problem worldwide. Surveys suggest that more than 50% of cancer patients suffer unrelieved pain. Unrelieved pain impairs all aspects of the patient's life - including appetite, mood, self-esteem, relationships with others, and even the ability to move. In some countries, the lack of pain relief has made some patients wish for death and even resort to inquiries about euthanasia and assisted suicide. The relief of pain has shown an improved quality of life for many cancer patients.
In 1986, the WHO announced that most, if not all, cancer pain could be relieved using a variety of drug and non-drug measures including opioids and analgesics.
Health care practitioners are encouraged to use the Three-Step Analgesic Method (WHO Analgesic Method), which was developed by the WHO in 1986, as an effective method to treat pain. Step One: Non-opioid medication, such as - paracetamol, Non-Steroidal Anti-Inflammatory Drugs ( NSAIDs) like aspirin, ibuprofen, naproxen, etc., and Coxibs (rofecoxib). Dr. Adriano Laudico, noted surgeon, personally uses and prefers rofecoxib (Vioxx) over other analgesics because of its efficacy in alleviating pain, as well as its protection of the stomach lining. NSAIDs are known to cause gastro intestinal upset like nausea, belching, heartburn, indigestion, stomach perforations, ulcers, even bleeding. When treating the pain of his cancer patients, Dr. Laudico believes that the right choice of pain medication can spare his patients from further pain and discomfort. Step Two: If this does not relieve the pain, the next step is to add to this a weak opiod (like codeine) for mild to moderate pain. Step Three : When cancer pain is moderate to severe, there is no substitute for morphine or others in the therapeutic group of strong opioids. "In patients with severe pain, morphine - a strong opioid - is the drug of choice" stated the participants of the 1986 WHO Meeting on the Comprehensive Management of Cancer Pain.
Opioids is a scientific term that refers to both natural and synthetic drugs whose effects are mediated by specific receptors in the central and peripheral nervous systems, including codeine, morphine, oxycodone, and fentanyl. Opioids, however, are classified as narcotic drugs because they have the potential for abuse, making it necessary to regulate these with international treaties and national drug control policies. Nevertheless, the International Narcotics Control Board (INCB), the international body that monitors the global availability of narcotic drugs, emphasizes that opioids should be available for pain relief. Morphine addiction is highly unlikely among patients who are treated for severe pain, whether due to cancer or other conditions.
The INCB, the WHO, and national governments report that opioids are not sufficiently available for medical purposes. It is unfortunate that in the Philippines, much to the dismay of many doctors treating cancer patients, morphine tablets and injectables are very difficult, if not nearly impossible, to obtain for cancer pain treatment because of overly restrictive regulations of the Dangerous Drugs Board (DDB) emanating from the Dangerous Drugs Acts of 1972 (RA6425). It is understandable that abuse of these narcotic analgesic drugs should be prevented, however, national policies and guidelines should not interfere with ensuring their availability for medical and scientific purposes - the principle of BALANCE emphasized in the "Single Convention on Narcotic Drugs" of 1961.
For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati, fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.
Cancer is described as the wild, uncontrolled, and abnormal growth of body cells. It can occur in any tissue or organ in any part of the body. If it occurs in the superficial part of the body, it can be more easily detected and treated. If it occurs deep within the body, often symptoms appear only in the later stages of the disease, making treatment more difficult. With early detection and modern methods, many cancers can be treated/.
However, those cases in the later stages of cancer can be a very painful ordeal. For this reason, national cancer control programmes have made the management of pain and other symptoms their primary aim. Tragically, cancer pain is often left untreated, if ever, treatment may be inadequate. The World Health Organization (WHO) has determined that inadequate management of cancer pain is a serious health problem worldwide. Surveys suggest that more than 50% of cancer patients suffer unrelieved pain. Unrelieved pain impairs all aspects of the patient's life - including appetite, mood, self-esteem, relationships with others, and even the ability to move. In some countries, the lack of pain relief has made some patients wish for death and even resort to inquiries about euthanasia and assisted suicide. The relief of pain has shown an improved quality of life for many cancer patients.
In 1986, the WHO announced that most, if not all, cancer pain could be relieved using a variety of drug and non-drug measures including opioids and analgesics.
Health care practitioners are encouraged to use the Three-Step Analgesic Method (WHO Analgesic Method), which was developed by the WHO in 1986, as an effective method to treat pain. Step One: Non-opioid medication, such as - paracetamol, Non-Steroidal Anti-Inflammatory Drugs ( NSAIDs) like aspirin, ibuprofen, naproxen, etc., and Coxibs (rofecoxib). Dr. Adriano Laudico, noted surgeon, personally uses and prefers rofecoxib (Vioxx) over other analgesics because of its efficacy in alleviating pain, as well as its protection of the stomach lining. NSAIDs are known to cause gastro intestinal upset like nausea, belching, heartburn, indigestion, stomach perforations, ulcers, even bleeding. When treating the pain of his cancer patients, Dr. Laudico believes that the right choice of pain medication can spare his patients from further pain and discomfort. Step Two: If this does not relieve the pain, the next step is to add to this a weak opiod (like codeine) for mild to moderate pain. Step Three : When cancer pain is moderate to severe, there is no substitute for morphine or others in the therapeutic group of strong opioids. "In patients with severe pain, morphine - a strong opioid - is the drug of choice" stated the participants of the 1986 WHO Meeting on the Comprehensive Management of Cancer Pain.
Opioids is a scientific term that refers to both natural and synthetic drugs whose effects are mediated by specific receptors in the central and peripheral nervous systems, including codeine, morphine, oxycodone, and fentanyl. Opioids, however, are classified as narcotic drugs because they have the potential for abuse, making it necessary to regulate these with international treaties and national drug control policies. Nevertheless, the International Narcotics Control Board (INCB), the international body that monitors the global availability of narcotic drugs, emphasizes that opioids should be available for pain relief. Morphine addiction is highly unlikely among patients who are treated for severe pain, whether due to cancer or other conditions.
The INCB, the WHO, and national governments report that opioids are not sufficiently available for medical purposes. It is unfortunate that in the Philippines, much to the dismay of many doctors treating cancer patients, morphine tablets and injectables are very difficult, if not nearly impossible, to obtain for cancer pain treatment because of overly restrictive regulations of the Dangerous Drugs Board (DDB) emanating from the Dangerous Drugs Acts of 1972 (RA6425). It is understandable that abuse of these narcotic analgesic drugs should be prevented, however, national policies and guidelines should not interfere with ensuring their availability for medical and scientific purposes - the principle of BALANCE emphasized in the "Single Convention on Narcotic Drugs" of 1961.
For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati, fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.
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