alexa Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study.
Healthcare

Healthcare

Journal of Palliative Care & Medicine

Author(s): Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA

Abstract Share this page

Abstract This paper reports on the experience gained using World Health Organization Guidelines for cancer pain relief over a 10-year period in an anaesthesiology-based pain service associated with a palliative care programme. The course of treatment of 2118 patients was assessed prospectively over a period of 140,478 treatment days. Non-opioid analgesics (WHO step I) were used on 11\%, weak opioids (WHO step II) on 31\% and strong opioids (WHO step III) on 49\% of treatment days. Administration was via the enteral route on 82\% and parenterally on 9\% of treatment days. On the remaining days, either spinally applied opioids (2\%) or other treatments (6\%) were utilised. Fifty-six percent of the patients were treated with morphine. Morphine dose escalation was observed in about one-half of the patients being cared for until death, whereas the other half had stable or decreasing doses over the course of treatment. Co-analgesics were administered on 37\% of days, most often antidepressants (15\%), anticonvulsants (13\%) and corticosteroids (13\%). Adjuvants to treat symptoms other than pain were prescribed on 79\% of days, most commonly laxatives (42\%), histamine-2-receptor antagonists (39\%) and antiemetics (35\%). In addition, palliative antineoplastic treatment was performed in 42\%, nerve blocks in 8\%, physiotherapy in 5\%, psychotherapy in 3\% and TENS in 3\% of patients. A highly significant pain reduction was achieved within the 1st week of treatment (P < 0.001). Over the whole treatment period, good pain relief was reported in 76\%, satisfactory efficacy in 12\% and inadequate efficacy in 12\% of patients. In the final days of life, 84\% rated their pain as moderate or less, while 10\% were unable to give a rating. Analgesics remained constantly effective in all 3 steps of the WHO ladder. Other clinical symptoms were likewise significantly reduced at 1 week after initial assessment, with the exception of neuropsychiatric symptoms. During the course of treatment, the latter were the major symptoms on 23\% of days, followed by nausea (23\%), constipation (23\%) and anorexia (20\%). Our results emphasise once again the marked efficacy and low rate of complications associated with oral and parenteral analgesic therapy as the mainstay of pain treatment in the palliative care of patients with advanced cancer. Wide dissemination of WHO guidelines among doctors and healthcare workers is thus necessary to effect a clear improvement in the treatment of the many patients suffering from cancer pain in the clinical and home setting.
This article was published in Pain and referenced in Journal of Palliative Care & Medicine

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

  • 26th World Cancer Convention
    November 27-28, 2017 Dubai, UAE
Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords