Modern Believing

Pain and Suffering in Cancer Patients

Modern Believing (2015), 56, (2), 145–162.

Abstract

Pain affects most cancer patients due to the disease itself or its treatment and recent studies indicate that persistent severe pain continues to be prevalent despite advances in treatment. The World Health Organization (WHO) ladder and liberal use of opioids still do not provide adequate pain relief in a quarter of patients and pain medicine consultants are often able to help many of them. Unfortunately despite all possible interventions we recognise that a small number of patients still continue to suffer severe uncontrolled pain. In others, whilst the severe physical pain may be controlled, they continue to suffer ‘mental and emotional pain’ in the form of suffering and loss of autonomy and may undergo existential crises. As such, questions as to the role of medicine, whether to relieve suffering in all its forms or simply to maintain existence without due regard for quality of life are raised.

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BAHN, B. & ERDEK, M. (2013) ‘Celiac Plexus Block and Neurolysis for Pancreatic Cancer’ Curr Pain Headache Rep. 17, pp. 1-7. ‘Celiac Plexus Block and Neurolysis for Pancreatic Cancer’ Curr Pain Headache Rep 17 1 7 Google Scholar

BALLANTYNE, J. C. (2007) ‘Opioid misuse in oncology pain patients’ Curr Pain Headache Rep. 11, pp. 276-82. ‘Opioid misuse in oncology pain patients’ Curr Pain Headache Rep 11 276 82 Google Scholar

BHASKAR, A. K. (2012) ‘Interventional management of cancer pain’ Curr Opin Support Palliat Care, 6, pp. 1-9. ‘Interventional management of cancer pain’ Curr Opin Support Palliat Care 6 1 9 Google Scholar

BREIVIK, H., CHERNY, N., COLLETT, B., DE CONNO, F., FILBET, M., FOUBERT, A. J., COHEN, R. & DOW, L. (2009) ‘Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes’ Ann Oncol. 20, pp. 1420-33. ‘Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes’ Ann Oncol 20 1420 33 Google Scholar

BRINKSCHMIDT, T. & NEUMEIER, S. (2011) ‘How to avoid opioid tolerance’ MMW Fortschr Med. 153, pp. 46-8. ‘How to avoid opioid tolerance’ MMW Fortschr Med 153 46 8 Google Scholar

CHANG, G., CHEN, L. & MAO, J. (2007) ‘Opioid tolerance and hyperalgesia’ Med Clin North Am. 91, pp. 199-211. ‘Opioid tolerance and hyperalgesia’ Med Clin North Am 91 199 211 Google Scholar

DALE, O., MOKSNES, K. & KAASA, S. (2011) ‘European Palliative Care Research Collaborative pain guidelines: opioid switching to improve analgesia or reduce side effects. A systematic review’ Palliative medicine. 25, p. 494. ‘European Palliative Care Research Collaborative pain guidelines: opioid switching to improve analgesia or reduce side effects. A systematic review’ Palliative medicine 25 494 Google Scholar

DAVIS, M. P. & WALSH, D. (2004) ‘Epidemiology of cancer pain and factors influencing poor pain control’ Am J Hosp Palliat Care. 21, pp. 137-42. ‘Epidemiology of cancer pain and factors influencing poor pain control’ Am J Hosp Palliat Care 21 137 42 Google Scholar

DEANDREA, S., MONTANARI, M., MOJA, L. & APOLONE, G. (2008) ‘Prevalence of undertreatment in cancer pain. A review of published literature’ Ann Oncol. 19, pp. 1985-91. ‘Prevalence of undertreatment in cancer pain. A review of published literature’ Ann Oncol 19 1985 91 Google Scholar

FERREIRA, K., KIMURA, M. & TEIXEIRA, M. (2006) ‘The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?’ Support Care Cancer. 14, pp. 1086-93. ‘The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?’ Support Care Cancer 14 1086 93 Google Scholar

FORBES, K. (2011) ‘Pain in Patients with Cancer: The World Health Organization Analgesic Ladder and Beyond’ Clinical Oncology 23, pp. 379-80. ‘Pain in Patients with Cancer: The World Health Organization Analgesic Ladder and Beyond’ Clinical Oncology 23 379 80 Google Scholar

FRIED, T. R., O'LEARY, J., VAN NESS, P. & FRAENKEL, L. (2007) ‘Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment’ J Am Geriatr Soc., 55, pp. 1007-14. ‘Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment’ J Am Geriatr Soc 55 1007 14 Google Scholar

GARDELL, L. R., KING, T., OSSIPOV, M. H., RICE, K. C., LAI, J., VANDERAH, T. W. & PORRECA, F. (2006) ‘Opioid receptor-mediated hyperalgesia and antinociceptive tolerance induced by sustained opiate delivery’ Neurosci Lett. 396, pp. 44-9. ‘Opioid receptor-mediated hyperalgesia and antinociceptive tolerance induced by sustained opiate delivery’ Neurosci Lett 396 44 9 Google Scholar

GROND, S., ZECH, D., SCHUG, S. A., LYNCH, J. & LEHMANN, K. A. (1991) ‘Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life’ J Pain Symptom Manage. 6, pp. 411-22. ‘Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life’ J Pain Symptom Manage 6 411 22 Google Scholar

HANSEN, H. N., CE. RACZ, GB. (2014) ‘The Evolving Role of Opioid Treatment in Chronic Pain Management, Pain and Treatment’ Available at: http://www.intechopen.com/books/pain-and-treatment/the-evolving-role-of-opioid-treatment-in-chronic-pain-management Google Scholar

KAY, S., HUSBANDS, E., ANTROBUS, J. H. & MUNDAY, D. (2007) ‘Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists’ Palliat Med. 21, pp. 279-84. ‘Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists’ Palliat Med 21 279 84 Google Scholar

KOTLINSKA-LEMIESZEK, A., PAULSEN, O., KAASA, S. & KLEPSTAD, P. (2014) ‘Polypharmacy in Patients With Advanced Cancer and Pain: A European Cross-sectional Study of 2282 Patients’ J Pain Symptom Manage. 48, pp. 1145-59. ‘Polypharmacy in Patients With Advanced Cancer and Pain: A European Cross-sectional Study of 2282 Patients’ J Pain Symptom Manage 48 1145 59 Google Scholar

LINKLATER, G. T., LENG, M. E., TIERNAN, E. J., LEE, M. A. & CHAMBERS, W. A. (2002) ‘Pain management services in palliative care: a national survey’ Palliat Med. 16, pp. 435-9. ‘Pain management services in palliative care: a national survey’ Palliat Med 16 435 9 Google Scholar

LYNESS, J. M. (2004) ‘End-of-life care: issues relevant to the geriatric psychiatrist’ Am J Geriatr Psychiatry. 12, pp. 457-72. ‘End-of-life care: issues relevant to the geriatric psychiatrist’ Am J Geriatr Psychiatry 12 457 72 Google Scholar

MEERA, A. (2011) ‘Pain and Opioid Dependence: Is it a Matter of Concern?’ Indian J Palliat Care. 17, pp. S36-8. ‘Pain and Opioid Dependence: Is it a Matter of Concern?’ Indian J Palliat Care 17 S36 8 Google Scholar

MERCADANTE, S. (2014) ‘Managing difficult pain conditions in the cancer patient’ Curr Pain Headache Rep. 18, p. 395. ‘Managing difficult pain conditions in the cancer patient’ Curr Pain Headache Rep 18 395 Google Scholar

MERCADANTE, S., GATTI, A., PORZIO, G., LO PRESTI, C., AIELLI, F., ADILE, C. & CASUCCIO, A. (2012) ‘Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses’ Curr Med Res Opin. 28, pp. 963-8. ‘Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses’ Curr Med Res Opin 28 963 8 Google Scholar

MODESTO-LOWE, V., GIRARD, L. & CHAPLIN, M. (2012) ‘Cancer pain in the opioid-addicted patient: can we treat it right?’ J Opioid Manag. 8, pp. 167-75. ‘Cancer pain in the opioid-addicted patient: can we treat it right?’ J Opioid Manag 8 167 75 Google Scholar

MORROW, G. R., ANDREWS, P. L., HICKOK, J. T., ROSCOE, J. A. & MATTESON, S. (2002) ‘Fatigue associated with cancer and its treatment’ Support Care Cancer. 10, pp. 389-98. ‘Fatigue associated with cancer and its treatment’ Support Care Cancer 10 389 98 Google Scholar

MULLER-SCHWEFE, G., AHLBECK, K., ALDINGTON, D., ALON, E., COACCIOLI, S., COLUZZI, F., HUYGEN, F., JAKSCH, W., KALSO, E., KOCOT-KEPSKA, M., KRESS, H. G., MANGAS, A. C., FERRI, C. M., MORLION, B., NICOLAOU, A., HERNANDEZ, C. P., PERGOLIZZI, J., SCHAFER, M. & SICHERE, P. (2014) ‘Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements’ Curr Med Res Opin. 30, p. 1-14. ‘Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements’ Curr Med Res Opin 30 1 14 Google Scholar

MUNGLANI, R. (2012) ‘Reflections on euthanasia, pain and suffering’ Journal of Obeervational Pain Medicine. 1, pp. 1-50. ‘Reflections on euthanasia, pain and suffering’ Journal of Obeervational Pain Medicine 1 1 50 Google Scholar

MUNGLANI, R. (2013) ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill: reflections on opioid therapy and the primary duty of medicine’ Pain News. 11, p. 5. ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill: reflections on opioid therapy and the primary duty of medicine’ Pain News 11 5 Google Scholar

MUNGLANI, R. (2014) ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill; reflections on opioid therapy and primary duty of medicine’ Journal of Observational Pain Medicine. 1, pp.1-8. ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill; reflections on opioid therapy and primary duty of medicine’ Journal of Observational Pain Medicine 1 1 8 Google Scholar

NOLTE, T. (2009) ‘Cancer pain: recommendations beyond the WHO-ladder’ MMW Fortschr Med. 151, pp. 33-5. ‘Cancer pain: recommendations beyond the WHO-ladder’ MMW Fortschr Med 151 33 5 Google Scholar

OOSTEN, A. W., OLDENMENGER, W. H., VAN ZUYLEN, C., SCHMITZ, P. I. M., BANNINK, M., LIEVERSE, P. J., BROMBERG, J. E. C. & VAN DER RIJT, C. C. D. (2011) ‘Higher doses of opioids in patients who need palliative sedation prior to death: Cause or consequence?’ European Journal of Cancer. 47, pp. 2341-6. ‘Higher doses of opioids in patients who need palliative sedation prior to death: Cause or consequence?’ European Journal of Cancer 47 2341 6 Google Scholar

PACHMAN, D. R., BARTON, D. L., SWETZ, K. M. & LOPRINZI, C. L. (2012) ‘Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain’ J Clin Oncol. 30, pp. 3687-96. ‘Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain’ J Clin Oncol 30 3687 96 Google Scholar

PRUE, G., RANKIN, J., ALLEN, J., GRACEY, J. & CRAMP, F. (2006) ‘Cancer-related fatigue: A critical appraisal’ Eur J Cancer. 42, pp. 846-63. ‘Cancer-related fatigue: A critical appraisal’ Eur J Cancer 42 846 63 Google Scholar

SILVERMAN, S. M. (2009) ‘Opioid induced hyperalgesia: clinical implications for the pain practitioner’ Pain Physician. 12, pp. 679-84. ‘Opioid induced hyperalgesia: clinical implications for the pain practitioner’ Pain Physician 12 679 84 Google Scholar

STEARNS, L., BOORTZ-MARX, R., DU PEN, S., FRIEHS, G., GORDON, M., HALYARD, M., HERBST, L. & KISER, J. (2005) ‘Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices’ J Support Oncol. 3, pp. 399-408. ‘Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices’ J Support Oncol 3 399 408 Google Scholar

UPADHYAY, S. P. & MALLICK, P. N. (2012) ‘Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management’ American Journal of Hospice and Palliative Medicine. 29, pp. 388-398. ‘Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management’ American Journal of Hospice and Palliative Medicine 29 388 398 Google Scholar

VALEBERG, B. T., RUSTOEN, T., BJORDAL, K., HANESTAD, B. R., PAUL, S. & MIASKOWSKI, C. (2008) ‘Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients’ Eur J Pain. 12, pp. 582-90. ‘Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients’ Eur J Pain 12 582 90 Google Scholar

VAN DEN BEUKEN-VAN EVERDINGEN, M. H. J., DE RIJKE, J. M., KESSELS, A. G., SCHOUTEN, H. C., VAN KLEEF, M. & PATIJN, J. (2007) ‘Prevalence of pain in patients with cancer: a systematic review of the past 40 years’ Annals of Oncology. 18, pp. 1437-49. ‘Prevalence of pain in patients with cancer: a systematic review of the past 40 years’ Annals of Oncology 18 1437 49 Google Scholar

VARGAS-SCHAFFER, G. (2010) ‘Is the WHO analgesic ladder still valid? Twenty-four years of experience’ Can Fam Physician. 56, 514-7, e202-5. ‘Is the WHO analgesic ladder still valid? Twenty-four years of experience’ Can Fam Physician 56 514 7 Google Scholar

VELLA-BRINCAT, J. & MACLEOD, A. D. (2007) ‘Adverse effects of opioids on the central nervous systems of palliative care patients’ J Pain Palliat Care Pharmacother. 21, pp. 15-25. ‘Adverse effects of opioids on the central nervous systems of palliative care patients’ J Pain Palliat Care Pharmacother 21 15 25 Google Scholar

VENTAFRIDDA, V., SAITA, L., RIPAMONTI, C. & DE CONNO, F. (1985) ‘WHO guidelines for the use of analgesics in cancer pain’ Int J Tissue React. 7, pp. 93-6. ‘WHO guidelines for the use of analgesics in cancer pain’ Int J Tissue React 7 93 6 Google Scholar

VOROBEYCHIK, Y., CHEN, L., BUSH, M. C. & MAO, J. (2008) ‘Improved opioid analgesic effect following opioid dose reduction’ Pain Med. 9, pp. 724-7. ‘Improved opioid analgesic effect following opioid dose reduction’ Pain Med 9 724 7 Google Scholar

WORLD HEALTH ORGANIZATION. (1986) Cancer pain relief, Geneva; Albany, NY, World Health Organization; WHO Publications Center USA distributor. Google Scholar

ZEPPETELLA, G. (2011) ‘The WHO analgesic ladder: 25 years on’ Br J Nurs. 20, S4, S6. ‘The WHO analgesic ladder: 25 years on’ Br J Nurs 20 S4 Google Scholar

BAHN, B. & ERDEK, M. (2013) ‘Celiac Plexus Block and Neurolysis for Pancreatic Cancer’ Curr Pain Headache Rep. 17, pp. 1-7. ‘Celiac Plexus Block and Neurolysis for Pancreatic Cancer’ Curr Pain Headache Rep 17 1 7 Google Scholar

BALLANTYNE, J. C. (2007) ‘Opioid misuse in oncology pain patients’ Curr Pain Headache Rep. 11, pp. 276-82. ‘Opioid misuse in oncology pain patients’ Curr Pain Headache Rep 11 276 82 Google Scholar

BHASKAR, A. K. (2012) ‘Interventional management of cancer pain’ Curr Opin Support Palliat Care, 6, pp. 1-9. ‘Interventional management of cancer pain’ Curr Opin Support Palliat Care 6 1 9 Google Scholar

BREIVIK, H., CHERNY, N., COLLETT, B., DE CONNO, F., FILBET, M., FOUBERT, A. J., COHEN, R. & DOW, L. (2009) ‘Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes’ Ann Oncol. 20, pp. 1420-33. ‘Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes’ Ann Oncol 20 1420 33 Google Scholar

BRINKSCHMIDT, T. & NEUMEIER, S. (2011) ‘How to avoid opioid tolerance’ MMW Fortschr Med. 153, pp. 46-8. ‘How to avoid opioid tolerance’ MMW Fortschr Med 153 46 8 Google Scholar

CHANG, G., CHEN, L. & MAO, J. (2007) ‘Opioid tolerance and hyperalgesia’ Med Clin North Am. 91, pp. 199-211. ‘Opioid tolerance and hyperalgesia’ Med Clin North Am 91 199 211 Google Scholar

DALE, O., MOKSNES, K. & KAASA, S. (2011) ‘European Palliative Care Research Collaborative pain guidelines: opioid switching to improve analgesia or reduce side effects. A systematic review’ Palliative medicine. 25, p. 494. ‘European Palliative Care Research Collaborative pain guidelines: opioid switching to improve analgesia or reduce side effects. A systematic review’ Palliative medicine 25 494 Google Scholar

DAVIS, M. P. & WALSH, D. (2004) ‘Epidemiology of cancer pain and factors influencing poor pain control’ Am J Hosp Palliat Care. 21, pp. 137-42. ‘Epidemiology of cancer pain and factors influencing poor pain control’ Am J Hosp Palliat Care 21 137 42 Google Scholar

DEANDREA, S., MONTANARI, M., MOJA, L. & APOLONE, G. (2008) ‘Prevalence of undertreatment in cancer pain. A review of published literature’ Ann Oncol. 19, pp. 1985-91. ‘Prevalence of undertreatment in cancer pain. A review of published literature’ Ann Oncol 19 1985 91 Google Scholar

FERREIRA, K., KIMURA, M. & TEIXEIRA, M. (2006) ‘The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?’ Support Care Cancer. 14, pp. 1086-93. ‘The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?’ Support Care Cancer 14 1086 93 Google Scholar

FORBES, K. (2011) ‘Pain in Patients with Cancer: The World Health Organization Analgesic Ladder and Beyond’ Clinical Oncology 23, pp. 379-80. ‘Pain in Patients with Cancer: The World Health Organization Analgesic Ladder and Beyond’ Clinical Oncology 23 379 80 Google Scholar

FRIED, T. R., O'LEARY, J., VAN NESS, P. & FRAENKEL, L. (2007) ‘Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment’ J Am Geriatr Soc., 55, pp. 1007-14. ‘Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment’ J Am Geriatr Soc 55 1007 14 Google Scholar

GARDELL, L. R., KING, T., OSSIPOV, M. H., RICE, K. C., LAI, J., VANDERAH, T. W. & PORRECA, F. (2006) ‘Opioid receptor-mediated hyperalgesia and antinociceptive tolerance induced by sustained opiate delivery’ Neurosci Lett. 396, pp. 44-9. ‘Opioid receptor-mediated hyperalgesia and antinociceptive tolerance induced by sustained opiate delivery’ Neurosci Lett 396 44 9 Google Scholar

GROND, S., ZECH, D., SCHUG, S. A., LYNCH, J. & LEHMANN, K. A. (1991) ‘Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life’ J Pain Symptom Manage. 6, pp. 411-22. ‘Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life’ J Pain Symptom Manage 6 411 22 Google Scholar

HANSEN, H. N., CE. RACZ, GB. (2014) ‘The Evolving Role of Opioid Treatment in Chronic Pain Management, Pain and Treatment’ Available at: http://www.intechopen.com/books/pain-and-treatment/the-evolving-role-of-opioid-treatment-in-chronic-pain-management Google Scholar

KAY, S., HUSBANDS, E., ANTROBUS, J. H. & MUNDAY, D. (2007) ‘Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists’ Palliat Med. 21, pp. 279-84. ‘Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists’ Palliat Med 21 279 84 Google Scholar

KOTLINSKA-LEMIESZEK, A., PAULSEN, O., KAASA, S. & KLEPSTAD, P. (2014) ‘Polypharmacy in Patients With Advanced Cancer and Pain: A European Cross-sectional Study of 2282 Patients’ J Pain Symptom Manage. 48, pp. 1145-59. ‘Polypharmacy in Patients With Advanced Cancer and Pain: A European Cross-sectional Study of 2282 Patients’ J Pain Symptom Manage 48 1145 59 Google Scholar

LINKLATER, G. T., LENG, M. E., TIERNAN, E. J., LEE, M. A. & CHAMBERS, W. A. (2002) ‘Pain management services in palliative care: a national survey’ Palliat Med. 16, pp. 435-9. ‘Pain management services in palliative care: a national survey’ Palliat Med 16 435 9 Google Scholar

LYNESS, J. M. (2004) ‘End-of-life care: issues relevant to the geriatric psychiatrist’ Am J Geriatr Psychiatry. 12, pp. 457-72. ‘End-of-life care: issues relevant to the geriatric psychiatrist’ Am J Geriatr Psychiatry 12 457 72 Google Scholar

MEERA, A. (2011) ‘Pain and Opioid Dependence: Is it a Matter of Concern?’ Indian J Palliat Care. 17, pp. S36-8. ‘Pain and Opioid Dependence: Is it a Matter of Concern?’ Indian J Palliat Care 17 S36 8 Google Scholar

MERCADANTE, S. (2014) ‘Managing difficult pain conditions in the cancer patient’ Curr Pain Headache Rep. 18, p. 395. ‘Managing difficult pain conditions in the cancer patient’ Curr Pain Headache Rep 18 395 Google Scholar

MERCADANTE, S., GATTI, A., PORZIO, G., LO PRESTI, C., AIELLI, F., ADILE, C. & CASUCCIO, A. (2012) ‘Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses’ Curr Med Res Opin. 28, pp. 963-8. ‘Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses’ Curr Med Res Opin 28 963 8 Google Scholar

MODESTO-LOWE, V., GIRARD, L. & CHAPLIN, M. (2012) ‘Cancer pain in the opioid-addicted patient: can we treat it right?’ J Opioid Manag. 8, pp. 167-75. ‘Cancer pain in the opioid-addicted patient: can we treat it right?’ J Opioid Manag 8 167 75 Google Scholar

MORROW, G. R., ANDREWS, P. L., HICKOK, J. T., ROSCOE, J. A. & MATTESON, S. (2002) ‘Fatigue associated with cancer and its treatment’ Support Care Cancer. 10, pp. 389-98. ‘Fatigue associated with cancer and its treatment’ Support Care Cancer 10 389 98 Google Scholar

MULLER-SCHWEFE, G., AHLBECK, K., ALDINGTON, D., ALON, E., COACCIOLI, S., COLUZZI, F., HUYGEN, F., JAKSCH, W., KALSO, E., KOCOT-KEPSKA, M., KRESS, H. G., MANGAS, A. C., FERRI, C. M., MORLION, B., NICOLAOU, A., HERNANDEZ, C. P., PERGOLIZZI, J., SCHAFER, M. & SICHERE, P. (2014) ‘Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements’ Curr Med Res Opin. 30, p. 1-14. ‘Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements’ Curr Med Res Opin 30 1 14 Google Scholar

MUNGLANI, R. (2012) ‘Reflections on euthanasia, pain and suffering’ Journal of Obeervational Pain Medicine. 1, pp. 1-50. ‘Reflections on euthanasia, pain and suffering’ Journal of Obeervational Pain Medicine 1 1 50 Google Scholar

MUNGLANI, R. (2013) ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill: reflections on opioid therapy and the primary duty of medicine’ Pain News. 11, p. 5. ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill: reflections on opioid therapy and the primary duty of medicine’ Pain News 11 5 Google Scholar

MUNGLANI, R. (2014) ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill; reflections on opioid therapy and primary duty of medicine’ Journal of Observational Pain Medicine. 1, pp.1-8. ‘Numbers needed to heal, numbers needed to harm, numbers needed to kill; reflections on opioid therapy and primary duty of medicine’ Journal of Observational Pain Medicine 1 1 8 Google Scholar

NOLTE, T. (2009) ‘Cancer pain: recommendations beyond the WHO-ladder’ MMW Fortschr Med. 151, pp. 33-5. ‘Cancer pain: recommendations beyond the WHO-ladder’ MMW Fortschr Med 151 33 5 Google Scholar

OOSTEN, A. W., OLDENMENGER, W. H., VAN ZUYLEN, C., SCHMITZ, P. I. M., BANNINK, M., LIEVERSE, P. J., BROMBERG, J. E. C. & VAN DER RIJT, C. C. D. (2011) ‘Higher doses of opioids in patients who need palliative sedation prior to death: Cause or consequence?’ European Journal of Cancer. 47, pp. 2341-6. ‘Higher doses of opioids in patients who need palliative sedation prior to death: Cause or consequence?’ European Journal of Cancer 47 2341 6 Google Scholar

PACHMAN, D. R., BARTON, D. L., SWETZ, K. M. & LOPRINZI, C. L. (2012) ‘Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain’ J Clin Oncol. 30, pp. 3687-96. ‘Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain’ J Clin Oncol 30 3687 96 Google Scholar

PRUE, G., RANKIN, J., ALLEN, J., GRACEY, J. & CRAMP, F. (2006) ‘Cancer-related fatigue: A critical appraisal’ Eur J Cancer. 42, pp. 846-63. ‘Cancer-related fatigue: A critical appraisal’ Eur J Cancer 42 846 63 Google Scholar

SILVERMAN, S. M. (2009) ‘Opioid induced hyperalgesia: clinical implications for the pain practitioner’ Pain Physician. 12, pp. 679-84. ‘Opioid induced hyperalgesia: clinical implications for the pain practitioner’ Pain Physician 12 679 84 Google Scholar

STEARNS, L., BOORTZ-MARX, R., DU PEN, S., FRIEHS, G., GORDON, M., HALYARD, M., HERBST, L. & KISER, J. (2005) ‘Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices’ J Support Oncol. 3, pp. 399-408. ‘Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices’ J Support Oncol 3 399 408 Google Scholar

UPADHYAY, S. P. & MALLICK, P. N. (2012) ‘Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management’ American Journal of Hospice and Palliative Medicine. 29, pp. 388-398. ‘Intrathecal Drug Delivery System (IDDS) for Cancer Pain Management’ American Journal of Hospice and Palliative Medicine 29 388 398 Google Scholar

VALEBERG, B. T., RUSTOEN, T., BJORDAL, K., HANESTAD, B. R., PAUL, S. & MIASKOWSKI, C. (2008) ‘Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients’ Eur J Pain. 12, pp. 582-90. ‘Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients’ Eur J Pain 12 582 90 Google Scholar

VAN DEN BEUKEN-VAN EVERDINGEN, M. H. J., DE RIJKE, J. M., KESSELS, A. G., SCHOUTEN, H. C., VAN KLEEF, M. & PATIJN, J. (2007) ‘Prevalence of pain in patients with cancer: a systematic review of the past 40 years’ Annals of Oncology. 18, pp. 1437-49. ‘Prevalence of pain in patients with cancer: a systematic review of the past 40 years’ Annals of Oncology 18 1437 49 Google Scholar

VARGAS-SCHAFFER, G. (2010) ‘Is the WHO analgesic ladder still valid? Twenty-four years of experience’ Can Fam Physician. 56, 514-7, e202-5. ‘Is the WHO analgesic ladder still valid? Twenty-four years of experience’ Can Fam Physician 56 514 7 Google Scholar

VELLA-BRINCAT, J. & MACLEOD, A. D. (2007) ‘Adverse effects of opioids on the central nervous systems of palliative care patients’ J Pain Palliat Care Pharmacother. 21, pp. 15-25. ‘Adverse effects of opioids on the central nervous systems of palliative care patients’ J Pain Palliat Care Pharmacother 21 15 25 Google Scholar

VENTAFRIDDA, V., SAITA, L., RIPAMONTI, C. & DE CONNO, F. (1985) ‘WHO guidelines for the use of analgesics in cancer pain’ Int J Tissue React. 7, pp. 93-6. ‘WHO guidelines for the use of analgesics in cancer pain’ Int J Tissue React 7 93 6 Google Scholar

VOROBEYCHIK, Y., CHEN, L., BUSH, M. C. & MAO, J. (2008) ‘Improved opioid analgesic effect following opioid dose reduction’ Pain Med. 9, pp. 724-7. ‘Improved opioid analgesic effect following opioid dose reduction’ Pain Med 9 724 7 Google Scholar

WORLD HEALTH ORGANIZATION. (1986) Cancer pain relief, Geneva; Albany, NY, World Health Organization; WHO Publications Center USA distributor. Google Scholar

ZEPPETELLA, G. (2011) ‘The WHO analgesic ladder: 25 years on’ Br J Nurs. 20, S4, S6. ‘The WHO analgesic ladder: 25 years on’ Br J Nurs 20 S4 Google Scholar

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Author details

Munglani, Rajesh

Bhaskar, Arun