Chronic Tumor-Related Pain
Chronic Tumor-Related Pain
Tumor-related pain is typically chronic and unmitigating irrespective of cancer stage and necessitates long-lasting, round-the-clock coverage. Drugs with long half-lives are preferred for maintenance therapy to eliminate the need for frequent dosing and to minimize possible breakthrough pain. The strategy for control of tumor pain involves two tiers: the first tier supplies baseline control and the second tier controls periods of breakthrough pain. Immediate-release and extended-release formulations have been developed that contain the ideal pharmacodynamic properties to deliver both types of control. Baseline pain control creates a niche for extended-release formulations, which supply continuous analgesic coverage. Extended-release formulations include modified-release morphine, sustained-release morphine, modified-release hydromorphone, and modified-release oxycodone (Table 1). Breakthrough pain is ideally treated with fast-acting, rapidly absorbed drugs with a short duration of action, attributes that are consistent with formulations such as transmucosal fentanyl. The goal is to individualize drug combinations to maximize the patient's pain-free periods and minimize adverse effects, thereby allowing normal daily functioning.
Opioid Formulations
Tumor-related pain is typically chronic and unmitigating irrespective of cancer stage and necessitates long-lasting, round-the-clock coverage. Drugs with long half-lives are preferred for maintenance therapy to eliminate the need for frequent dosing and to minimize possible breakthrough pain. The strategy for control of tumor pain involves two tiers: the first tier supplies baseline control and the second tier controls periods of breakthrough pain. Immediate-release and extended-release formulations have been developed that contain the ideal pharmacodynamic properties to deliver both types of control. Baseline pain control creates a niche for extended-release formulations, which supply continuous analgesic coverage. Extended-release formulations include modified-release morphine, sustained-release morphine, modified-release hydromorphone, and modified-release oxycodone (Table 1). Breakthrough pain is ideally treated with fast-acting, rapidly absorbed drugs with a short duration of action, attributes that are consistent with formulations such as transmucosal fentanyl. The goal is to individualize drug combinations to maximize the patient's pain-free periods and minimize adverse effects, thereby allowing normal daily functioning.
