Cancer and tumor pain

Summary

Cancer and tumor pain (CTP) is traditionally described as resulting from somatic, visceral, or neuropathic origins. NSAIDs have been deemed the preferred class for bony (or somatic) pain. Opioids have been considered beneficial for visceral, but not bony or neuropathic CTP. While agents such as sedatives may be helpful in patient management, the adjuvant medications are believed to augment efficacy of coadministered opioids or NSAIDs. Anticonvulsants are frequently used as an adjunct for the treatment of neuropathic CTP. For bone pain, bisphosphonates, in particular pamidronate and zoledronic acid, are shown in multiple trials to be effective in reducing bony CTP from metastatic disease. The corticosteroids are, at best, marginally effective as an opioid-sparing adjunct for CTP in general, this class may have a role in tumor-related bowel obstruction. The antisecretory agents aim to relieve bowel obstruction CTP and eliminate the need for uncomfortable nasogastric tubes.