Effective Pain Management: Analgesic Principles for Acute & Cancer Pain

Pain is a subjective experience and pain management requires a comprehensive treatment approach and thorough evaluation of the patient's overall well being and level of functioning. Several treatment options are available for the management of pain, offering pain relief for all types and levels of pain.

Choice of Analgesia for Acute Pain or Cancer Pain

• Pain management should be initiated with the lowest dose of the safest drug available to achieve adequate pain relief. If the first drug choice does not relieve pain, another drug may be added to the therapy, or a stronger analgesic agent may be initiated.

Classifications of Pain

• Acute pain is normally associated with a definitive pathology, such as illness, trauma, injury or surgery. The symptoms of acute pain usually resolve when the underlying cause of the pain is healed. Chronic malignant pain, including cancer pain, is pain associated with potentially life-threatening conditions.

Goals of Pain Management

• The goals of pain management in all types of pain include decreasing pain, increasing function and restoring overall quality of life. Additionally, the appropriate analgesic agent should provide effective pain relief with the fewest side effects possible.

Non-Opioid Analgesics

• Acetaminophen, aspirin and non-steroidal anti-inflammatory agents are considered first-line treatment owing to their effectiveness and safety in the treatment of mild to moderate pain.

Opioid Analgesics

• Opioid agents are the next level of treatment and are effective for pain that isn't relieved by acetaminophen, aspirin or NSAIDs. Opioid agents present more side effects than other classes of analgesic agents.

Combination Pharmacological Treatment

• The World Health Organization recommends treating pain, particularly pain associated with cancer, with combination therapy including opioids and NSAIDs, with or without psychological intervention or other nonpharmacological therapy. This often provides effective pain relief while minimizing the adverse effects associated with each individual class of analgesic agents.