Challenges in managing cancer pain

Effective pain control is a key factor in cancer management, and is primarily achieved through drug therapy. Despite the World Health Organization (WHO) guidelines for cancer pain management, many cancer patients still do not receive adequate analgesia. Lack of knowledge and misconceptions about opioid treatment is a key contributing factor, along with shortcomings in the WHO guidelines themselves. Evidence shows that starting treatment with strong opioids can provide significantly greater benefits than being treated according to the WHO recommended 'analgesic ladder' - a sequential escalation of treatment. There is, therefore, a need for alternative treatment strategies that optimise drug selection, dose and methods of administration. Although widely used, drug delivery through the oral routes is not always acceptable for cancer patients with oral and gastrointestinal problems, and as such a range of administration routes, including transdermal, transmucosal and intranasal routes should be considered. Promising clinical outcomes with treatments such as transdermal fentanyl and intranasal fentanyl spray lend support to the opinion that strong opioids, used in appropriate formulations and doses, play an important role in the care of patients with severe pain.