guidelines can be followed in devising a chronic analgesic regimen for treating
Guidelines frequently followed when treating
cancer pain use a combination of different classes of analgesics to minimize
the side-effects of any one medication. The com-bination should utilize drugs
that work on the pain path-ways at different levels, so that the analgesics can
have additive/synergistic effects.
A typical cancer pain regimen includes:
with a set dose and extended-release mechanism (Table 76.1): act on opioid
receptors in the brain and the spinal cord.
act by primarily inhibiting prostaglandin synthe-sis causing desensitization of
peripheral pain receptors.
act by inhibiting the reuptake of serotonin and norepinephrine, which results
in stimulation of the descending inhibitory pain tracts in the spinal cord.
(optional): act on the neuropathic components of pain.
short-duration analgesics: given on a “prn” basis for episodic, breakthrough pain.