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ESMO E-Learning: Practical Tips for the Management of Difficult Pain Problems


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Learning objectives

  • To be familiar with stepwise approach to the management of difficult pain problems.
  • To learn about different analgesic interventions and approaches for the management of difficult pain problems.
  • To understand how to safely titrate adequate analgesic therapy in cancer patients with difficult pain syndromes.


Pain is one of the most common reasons cancer patients seek medical advice, so it is inevitable that oncologists should know how to deal with difficult-to-treat pain problems. Knowledge about pain management is paramount in the comprehensive treatment of cancer patients. Familiarity with opioids, adjuvants, and procedures that can abate pain in cancer patients is discussed in this module in a practical way for clinical application.

This presentation is a very concise overview of the stepwise approach to the management of difficult pain problems. Through practical examples, it describes the role of primary therapies in addressing the underlying cause of the pain. Furthermore in a very straightforward way, it illustrates how to titrate opioids up to a maximal tolerated dose and by different routes of administration, as well as how to manage opioid side effects. It also provides practical tips about the role of adjuvant analgesics, regional anaesthetic approaches, invasive neuroablative interventions, and the use of sedation in the management of refractory pain at the end of life.

Declaration of interest

Nathan I. Cherny has reported:
Unrestricted educational grant from Perdue Pharma

Last update: 22 Sep 2010

This E-Learning module was published in 2010. The CME test expired in 2012.

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