hematology and oncology
Management of Adverse Effects of Cancer Therapy
Pain
 Overview of Pain , including Pain is often under treated, for several reasons, including Patient reluctance to discuss pain with the physician Physician reluctance to discuss pain Fear of opioid addiction None of these is a sensible reason not to achieve adequate pain control in a patient with cancer. Treatment of Pain might include Use of multiple drug classes may provide better pain control with fewer or less severe adverse effects than use of a single drug class.Aspirinand nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with thrombocytopenia. Neuropathic pain can be treated withgabapentin; the dose required is high (up to 1200 mg orally 3 times a day) but must be started low (eg, 300 mg 3 times a day) and then increased over a few weeks. Alternatively, a tricyclic antidepressant (eg,nortriptyline, 25 to 75 mg orally at bedtime) can be tried. Doses can vary to a large degree between patients. Opioids are the mainstay of pain control in patients with cancer and are often underused. Pain medication should be given at doses and schedules which achieve the target level of pain control. Too often people with cancer receive inadequate pain control. Other approaches may be needed to control pain under special circumstances. For example, radiation therapy often is needed for bone pain. Nerve blockade and surgery may be done to interrupt the nerve pathways. 