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

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.