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[Basic Knowledge of Drug Pain Therapy in the Palliative Situation].
Dtsch Med Wochenschr. 2020 Jul; 145(13):917-925.DM

Abstract

This review provides an overview of the basic knowledge of drug pain therapy in the palliative situation. Pain is one of the main symptoms in 60 to 90 % of cancer patients. Pain also develops with neurological and other diseases that occur in end-of-life situations. To address this symptom, a holistic strategy is required that encompasses all physical, psychological, social, and spiritual aspects of the multi-dimensional pain experience ("total pain" concept).Drug treatment for cancer pain has been based on a stepwise approach for many years, starting with non-opioid analgesics, followed by moderate and strong opioids. In contrast, today's pain management is determined more by the actual intensity of this aversive event.The pain assessment should be tailored to identify a nociceptive vs. neuropathic pain component that needs to be challenged by the most appropriate drug therapies. Non-opioid analgesics are ideal substances for relieving nociceptive pain. Antidepressants and anticonvulsants reduce the intensity of new neuropathic pain. Opioids are suitable for all types of pain, but are restricted to a second line choice. Among all opioids are tilidine and tramadol prodrugs, which only relieve pain after activation in the liver. Drug-drug interactions may also block this activation. Rapid release opioids should be used for cancer breakthrough pain. Transdermal opioid applications are recommended for swallowing disorders, but usually not to initiate pain control. An opioid switch can be performed if side effects such as hallucinations for the selected opioid are more pronounced than the pain reduction.

Authors+Show Affiliations

Klinik für Palliativmedizin, Medizinische Fakultät Uniklinik RWTH Aachen. Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät Uniklinik RWTH Aachen.Institut für Physiologie, Medizinische Fakultät Uniklinik RWTH Aachen.Institut für Klinische Pharmakologie, Medizinische Fakultät Uniklinik RWTH Aachen.Klinik für Palliativmedizin, Medizinische Fakultät Uniklinik RWTH Aachen.Klinik für Palliativmedizin, Medizinische Fakultät Uniklinik RWTH Aachen.Klinik für Palliativmedizin, Medizinische Fakultät Uniklinik RWTH Aachen.Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät Uniklinik RWTH Aachen.Klinik für Palliativmedizin, Medizinische Fakultät Uniklinik RWTH Aachen.

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

32615607

Citation

Weber, Sascha, et al. "[Basic Knowledge of Drug Pain Therapy in the Palliative Situation]." Deutsche Medizinische Wochenschrift (1946), vol. 145, no. 13, 2020, pp. 917-925.
Weber S, Lampert A, Stingl J, et al. [Basic Knowledge of Drug Pain Therapy in the Palliative Situation]. Dtsch Med Wochenschr. 2020;145(13):917-925.
Weber, S., Lampert, A., Stingl, J., Peuckmann-Post, V., Hiddemann, S., Elsner, F., Neuner, I., & Rolke, R. (2020). [Basic Knowledge of Drug Pain Therapy in the Palliative Situation]. Deutsche Medizinische Wochenschrift (1946), 145(13), 917-925. https://doi.org/10.1055/a-1016-9941
Weber S, et al. [Basic Knowledge of Drug Pain Therapy in the Palliative Situation]. Dtsch Med Wochenschr. 2020;145(13):917-925. PubMed PMID: 32615607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Basic Knowledge of Drug Pain Therapy in the Palliative Situation]. AU - Weber,Sascha, AU - Lampert,Angelika, AU - Stingl,Julia, AU - Peuckmann-Post,Vera, AU - Hiddemann,Sonja, AU - Elsner,Frank, AU - Neuner,Irene, AU - Rolke,Roman, Y1 - 2020/07/02/ PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline SP - 917 EP - 925 JF - Deutsche medizinische Wochenschrift (1946) JO - Dtsch. Med. Wochenschr. VL - 145 IS - 13 N2 - This review provides an overview of the basic knowledge of drug pain therapy in the palliative situation. Pain is one of the main symptoms in 60 to 90 % of cancer patients. Pain also develops with neurological and other diseases that occur in end-of-life situations. To address this symptom, a holistic strategy is required that encompasses all physical, psychological, social, and spiritual aspects of the multi-dimensional pain experience ("total pain" concept).Drug treatment for cancer pain has been based on a stepwise approach for many years, starting with non-opioid analgesics, followed by moderate and strong opioids. In contrast, today's pain management is determined more by the actual intensity of this aversive event.The pain assessment should be tailored to identify a nociceptive vs. neuropathic pain component that needs to be challenged by the most appropriate drug therapies. Non-opioid analgesics are ideal substances for relieving nociceptive pain. Antidepressants and anticonvulsants reduce the intensity of new neuropathic pain. Opioids are suitable for all types of pain, but are restricted to a second line choice. Among all opioids are tilidine and tramadol prodrugs, which only relieve pain after activation in the liver. Drug-drug interactions may also block this activation. Rapid release opioids should be used for cancer breakthrough pain. Transdermal opioid applications are recommended for swallowing disorders, but usually not to initiate pain control. An opioid switch can be performed if side effects such as hallucinations for the selected opioid are more pronounced than the pain reduction. SN - 1439-4413 UR - https://www.unboundmedicine.com/medline/citation/32615607/[Basic_Knowledge_of_Drug_Pain_Therapy_in_the_Palliative_Situation] L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/a-1016-9941 DB - PRIME DP - Unbound Medicine ER -
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