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Drs Eduardo D. Bruera and Russell K. Portenoy have completely revised and updated the widely respected Cancer Pain: Assessment and Management for the second edition of this unanimously praised book. This is a comprehensive, clinically oriented review of all aspects of the complex and multidimensional problem of cancer pain. The unique characteristics of cancer pain, including pathophysiology, clinical assessment, diagnosis, and pharmacological and nonpharmacological management are all discussed here in detail. Internationally recognized leaders in cancer pain research have contributed to many new chapters, including neuraxial analgesia, hospice and institution-based palliative care programs, bone pain, and cancer pain and palliative care in the developing world. Cancer Pain continues to be a scholarly but accessible text that is an essential resource for physicians, nurses, and medical students who treat suffering from cancer pain.

Cancer pain.

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Cancer pain --- Treatment.

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Cancer pain --- Analgesia

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Cancers are among the leading causes of morbidity and mortality worldwide, responsible for 18.1 million new cases and 9.6 million deaths in 2018. Pain is experienced by 55% of patients undergoing anti-cancer treatment and by 66% of patients who have advanced, metastatic, or terminal disease. This can be relieved in most cases through medicines and other treatments. The World Health Organization (WHO) has developed Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to initiating and managing cancer pain. The aims of these guidelines are to provide guidance to health-care providers (i.e. the end-users of these guidelines: physicians, nurses, pharmacists and caregivers) on the adequate relief of pain associated with cancer. They also assist policy-makers, programme managers and public health personnel to create and facilitate appropriately balanced policies on opioids and prescribing regulations for effective and safe cancer pain management. Proper and effective stewardship of opioid analgesics in the cancer treatment setting is essential to ensure the safety of patients and to reduce the risk of diversion of medicine into society. The goal of cancer pain management is to relieve pain to a level that allows for an acceptable quality of life. The last set of WHO guidelines focused on cancer pain management were issued in 1996. The clinical guidelines and recommendations in this document are organized into three focal areas: - Analgesia of cancer pain: This addresses the choice of analgesic medicine when initiating pain relief and the choice of opioid for maintenance of pain relief, including optimization of rescue medication, route of administration, and opioid rotation and cessation. - Adjuvant medicines for cancer pain: This includes the use of steroids, antidepressants and anticonvulsants as adjuvant medicines. - Management of pain related to bone metastases: This incorporates the use of bisphosphonates and radiotherapy to manage bone metastases.

Cancer pain --- Treatment.

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Constipation is a condition with slow and incomplete bowel evacuation and a pathological increase in the digestive tract transit time. Constipation has a negative influence on the quality of life of cancer patients. The use of opioids is a frequent cause of non-obstructive constipation. The Norwegian Knowledge Centre for the Health Services was asked by The Norwegian Directorate of Health to evaluate efficacy, safety, cost effectiveness and ethical aspects regarding use of methylnaltrexone as adjuvant treatment in patients with cancer in palliative care. Methods We searched for studies in several databases. Included studies were critically reviewed. The evidence base was evaluated using GRADE. A simple health economic model was developed using TreeAge software. Results1. We identified two relevant randomised controlled trials which compared methylnaltrexone to placebo, with a total of 287 patients. Methylnaltrexone was significantly more effective in terms of response within 4 hours, both following the initial dose as well as repeated doses. In the double blind period abdominal pain was the most common adverse effect.2. We found a cost per quality adjusted life year of NOK 718 000. The sensitivity analyses showed that the results were particularly sensitive to the assumptions on quality of life, and the clinical evidence.3. Ethically methylnaltrexone makes it possible to treat vulnerable patients. The treatment can also ease the care for these patients. Low efficiency calls for prioritization. Conclusions Our review suggests that methylnaltrexone was more effective than placebo in terms of time to laxation. From an ethical point of view methylnaltrexone may contribute to help a vulnerable patient group and professionals in everyday care. Our health economic model nevertheless does not provide us with the grounds to conclude that the drug is cost-effective.

Cost effectiveness. --- Cancer pain --- Treatment.