Display options
Cite
Cherny NI, Portenoy RK, Raber M, et al. Medikamentöse Therapie von Tumorschmerzen : Teil 1: Eigenschaften von Nichtopioiden und Opioiden. [Drug therapy for tumor pain I. Properties of non-opioids and opioids.]. Schmerz. 1994;8(4):195-209doi: 10.1007/BF02527887.
Cherny, N. I., Portenoy, R. K., Raber, M., & Zenz, M. (1994). Medikamentöse Therapie von Tumorschmerzen : Teil 1: Eigenschaften von Nichtopioiden und Opioiden. [Drug therapy for tumor pain I. Properties of non-opioids and opioids.]. Schmerz (Berlin, Germany), 8(4), 195-209. https://doi.org/10.1007/BF02527887
Cherny, N I, et al. "Medikamentöse Therapie von Tumorschmerzen : Teil 1: Eigenschaften von Nichtopioiden und Opioiden." [Drug therapy for tumor pain I. Properties of non-opioids and opioids.]. Schmerz (Berlin, Germany) vol. 8,4 (1994): 195-209. doi: https://doi.org/10.1007/BF02527887
Cherny NI, Portenoy RK, Raber M, Zenz M. Medikamentöse Therapie von Tumorschmerzen : Teil 1: Eigenschaften von Nichtopioiden und Opioiden. [Drug therapy for tumor pain I. Properties of non-opioids and opioids.]. Schmerz. 1994 Dec;8(4):195-209. doi: 10.1007/BF02527887. German. PMID: 18415458.
Copy Download .nbib Format: NLM
Share it on

Schmerz. 1994 Dec;8(4):195-209. doi: 10.1007/BF02527887.

[Drug therapy for tumor pain I. Properties of non-opioids and opioids.].

Schmerz (Berlin, Germany)

[Article in German]
N I Cherny, R K Portenoy, M Raber, M Zenz

Affiliations

  1. Department Internal Medicine and Medical Oncology, Shaare-Zedek Medical Center, 91031, Jerusalem, Israel.

PMID: 18415458 DOI: 10.1007/BF02527887

Abstract

Analgesic pharmacotherapy represents one of the major approaches to the treatment of cancer pain, since it is used in almost every patient. A thorough evaluation of the physical and mental status of the patient and of the pain is as necessary as a sound understanding of the pharmacokinetic and pharmacodynamic characteristics of the analgesics selected. The World Health Organization (WHO) has issued a basic 3 stage progression for the treatment of cancer pain, the "WHO Analgesic Ladder". Assignment to the stages depends mainly on the intensity of the pain rather than on its specific aetiology. Mild to moderate pain is treated with non-opioid drugs; moderate to severe pain, with a combination of a "weak" opioid and a non-opioid; and "strong" opioids should be used in combination with a non-opioid in the case of severe pain. Adjuvant drugs can be added if specifically indicated. Nonopioid analgesics include non-acidic compounds, e. g. paracetamol and metamizole, and acidic non-opioids, e. g. acetylsalicylic acid and newer non-steroidal anti-inflammatory drugs (NSAID). In contrast to most of the opioid analgesics, they have a ceiling effect for analgesia. Addiction and tolerance are extremely rare concerns. Opioids can be subgrouped into "weak" (e. g., codeine, dextropropoxyphene) and "strong" opioids (e. g., morphine) and also into drugs interacting with different opioid-receptor subtypes. Whereas pure agonists (e. g., morphine) produce increasingly intense analgesia with increasing dose, partial agonists and agonist-antagonists have a ceiling effect for analgesia and therefore have only a minor role in the treatment of chronic pain in cancer patients. Adverse effects occur in most patients in a dose-dependent manner. The most common of these is constipation; nausea, vomiting and sedation occur mostly at the start and can usually be treated effectively. The appropriate dosage, route of administration and dosage scheme of analgesics needs to be worked out for each individual patient in intensive work with the patient and a close follow-up, for years if necessary. Some analgesics may not be available in some countries, or only in specific preparations.

References

  1. Ann Intern Med. 1977 Jun;86(6):738-41 - PubMed
  2. Clin Pharmacol Ther. 1991 Apr;49(4):350-4 - PubMed
  3. Am J Med. 1984 Sep 10;77(3A):38-53 - PubMed
  4. Br J Anaesth. 1990 May;64(5):547-50 - PubMed
  5. J Pain Symptom Manage. 1991 Oct;6(7):411-22 - PubMed
  6. Life Sci. 1987 Dec 28;41(26):2845-9 - PubMed
  7. Lancet. 1977 Feb 19;1(8008):398-9 - PubMed
  8. Int J Clin Pharmacol. 1974 Apr;7(3):184-98 - PubMed
  9. Clin Pharmacol Ther. 1989 Jan;45(1):66-71 - PubMed
  10. J Pain Symptom Manage. 1988 Summer;3(3):145-9 - PubMed
  11. Br J Clin Pharmacol. 1982 May;13(5):665-73 - PubMed
  12. J Neurosurg. 1986 Jun;64(6):890-4 - PubMed
  13. Pharmacotherapy. 1986 Sep-Oct;6(5):228-35 - PubMed
  14. Pain. 1991 Oct;47(1):13-19 - PubMed
  15. Anesthesiology. 1989 Jun;70(6):928-34 - PubMed
  16. Anaesthesia. 1987 Jul;42(7):727-31 - PubMed
  17. Am J Med. 1984 Jul 13;77(1A):78-83 - PubMed
  18. Cancer Treat Rep. 1979 Mar;63(3):457-9 - PubMed
  19. JAMA. 1984 Mar 2;251(9):1182-8 - PubMed
  20. Clin Pharmacol Ther. 1990 May;47(5):565-77 - PubMed
  21. Pain. 1990 Dec;43(3):273-286 - PubMed
  22. N Engl J Med. 1985 Jul 11;313(2):84-95 - PubMed
  23. Pain. 1989 Jul;38(1):1-7 - PubMed
  24. N Engl J Med. 1991 Jun 13;324(24):1716-25 - PubMed
  25. Clin Pharmacol Ther. 1980 Sep;28(3):417-24 - PubMed
  26. J Pharmacol Exp Ther. 1982 Oct;223(1):203-6 - PubMed
  27. Am J Med. 1988 May 20;84(5A):3-15 - PubMed
  28. J Pain Symptom Manage. 1990 Feb;5(1):27-32 - PubMed
  29. Pain. 1991 Apr;45(1):11-15 - PubMed
  30. Clin Pharmacol Ther. 1987 May;41(5):556-61 - PubMed
  31. Ann Intern Med. 1983 Dec;99(6):870-3 - PubMed
  32. Arthritis Rheum. 1982 Aug;25(8):1013-5 - PubMed
  33. Clin Pharmacol Ther. 1966 Nov-Dec;7(6):740-51 - PubMed
  34. Clin Pharmacol Ther. 1992 Apr;51(4):422-31 - PubMed
  35. Drugs. 1993 Aug;46(2):313-40 - PubMed
  36. Clin Pharmacol Ther. 1981 Nov;30(5):629-35 - PubMed
  37. Pain. 1989 Apr;37(1):97-101 - PubMed
  38. Clin Pharmacol Ther. 1982 Feb;31(2):157-67 - PubMed
  39. Br J Clin Pharmacol. 1983 Jul;16(1):85-93 - PubMed
  40. World Health Organ Tech Rep Ser. 1990;804:1-75 - PubMed
  41. J Pain Symptom Manage. 1986 Fall;1(4):203-7 - PubMed
  42. CMAJ. 1989 Mar 15;140(6):653-7, 661 - PubMed
  43. Am J Psychiatry. 1987 Aug;144(8):1062-5 - PubMed
  44. J Pharmacol Exp Ther. 1992 Jan;260(1):275-85 - PubMed
  45. Life Sci. 1990;47(6):579-85 - PubMed
  46. Pain. 1991 May;45(2):149-153 - PubMed
  47. Lancet. 1991 Feb 23;337(8739):465-8 - PubMed
  48. Postgrad Med. 1989 Mar;85(4):319-23, 326-9 - PubMed
  49. Am J Med. 1986 Mar 24;80(3A):83-7 - PubMed
  50. Cancer. 1987 Feb 15;59(4):850-6 - PubMed
  51. Br J Clin Pharmacol. 1979;7 Suppl 3:297S-308S - PubMed
  52. Ann Neurol. 1983 Feb;13(2):180-5 - PubMed
  53. Cancer. 1989 Jun 1;63(11 Suppl):2321-7 - PubMed
  54. Clin Pharmacol Ther. 1987 Apr;41(4):392-401 - PubMed
  55. J Pharmacol Exp Ther. 1989 Nov;251(2):477-83 - PubMed
  56. Pain. 1988 Jun;33(3):313-322 - PubMed
  57. N Engl J Med. 1981 Jun 18;304(25):1501-5 - PubMed
  58. Pain. 1977 Apr;3(2):93-104 - PubMed
  59. Arch Intern Med. 1987 Jul;147(7):1213-8 - PubMed
  60. Pain. 1991 May;45(2):141-143 - PubMed
  61. J Pain Symptom Manage. 1991 Oct;6(7):431-6 - PubMed
  62. Anaesthesia. 1990 Jul;45(7):538-42 - PubMed
  63. J Pharmacol Exp Ther. 1993 Oct;267(1):331-40 - PubMed
  64. Med Clin North Am. 1987 Mar;71(2):207-32 - PubMed
  65. Pain. 1992 May;49(2):249-256 - PubMed
  66. N Engl J Med. 1984 May 10;310(19):1213-7 - PubMed
  67. Br Med J (Clin Res Ed). 1986 Jun 14;292(6535):1548-9 - PubMed
  68. Tohoku J Exp Med. 1971 Sep;105(1):45-52 - PubMed
  69. Clin Pharmacol Ther. 1985 Dec;38(6):631-41 - PubMed
  70. Ann Intern Med. 1988 Sep 1;109(5):353-4 - PubMed
  71. J Clin Pharmacol. 1988 Dec;28(s1):S47-54 - PubMed
  72. Nat New Biol. 1971 Jun 23;231(25):232-5 - PubMed
  73. Br J Anaesth. 1990 Oct;65(4):448-55 - PubMed
  74. Br J Clin Pharmacol. 1980 Oct;10 Suppl 2:343S-346S - PubMed
  75. Clin Pharmacol Ther. 1988 May;43(5):542-6 - PubMed
  76. Br J Anaesth. 1988 May;60(6):608-13 - PubMed
  77. Ann Intern Med. 1986 Mar;104(3):399-404 - PubMed
  78. Pain. 1990 Jan;40(1):21-28 - PubMed
  79. Anesth Analg. 1989 Jul;69(1):21-7 - PubMed
  80. Drugs. 1986;32 Suppl 4:8-26 - PubMed

Publication Types