Pain therapy Part V. Cancer pain

Pain, along with heart rate, breath frequency and temperature should be considered as a vital parameter routinely assessed during patient's examination. Pain is suffered on over 60% persons with cancer and in advanced period of disease even in 90%. As the disease proceeds new -different causes and kinds of pain appear. Pain in a patient with cancer may be caused not only by the disease itself but also by diagnostic and therapeutic procedures. In order to improve the treatment the World Health Organization in 1984 proposed a systematized method of cancer pain therapy. In 1986 the first standards were published as so-called "analgetic ladder" (Cancer Pain Relief. WHO, Geneva 1986). It was of considerable influence on the effects of therapy in patients suffering of cancer pain as well as in patients with non-cancer pain. The suggestion of the "three steps ladder" is to start at the first step and to proceed to higher steps if the relief in pain is to be achieved. It is now well known that the WHO ladder is only to suggest the mode of pain therapy and is not to be arbitrarily observed and considered as the only proper method. Suggestions appear that there is time to modify the scheme introduced 23 years ago. Nevertheless opinion that opioids are the fundamental drugs in cancer pain treatment has not changed. It is indispensable that access to these drugs be easy and prompt for all the patients.