Elsevier

Lung Cancer

Volume 68, Issue 1, April 2010, Pages 10-15
Lung Cancer

Review
Pain in patients with lung cancer: Pathophysiology and treatment

https://doi.org/10.1016/j.lungcan.2009.11.004Get rights and content

Abstract

This review analyses the characteristics of the principal pain syndromes associated with lung cancer, their physiopathology and causes, and provides updated information on available treatments. Pain associated with lung cancer is characterized by multiple expressions, due to either the progression of disease and/or induced by oncological treatment. The analgesic treatment is principally based on the use of opioids. Other than the oral route, which is the preferred one, alternative modalities to administer opioids may be helpful in different clinical circumstances. According to the opioid response, other routes and other opioids, may improve the balance between analgesia and adverse effects providing the best individual response to a specific opioid drug. More complex strategies, such as interventional procedures, are seldom necessary and require an appropriate selection of patients.

Section snippets

Methods

A MEDLINE literature review for all studies published in the English language since 1990 was performed by using the following medical subject heading terms: cancer pain and lung cancer. Case reports were excluded. Authoritative reviews or chapters were reviewed. Pertinent articles were arbitrarily chosen according to the intention of the review to provide an overview on the principal characteristics of pain in patients with lung cancer and the available analgesic treatments.

Pain due to progression of disease

Pain most commonly occurs as a direct consequence of the malignancy. Pain is often multifactorial in origin and patients often experience pain in more than one anatomical site [4]. Other than disease itself, treatments may produce important pain syndromes, with a weighted prevalence of 13% [2], particularly after thoracic surgery [5] or radiotherapy [6] (see below). Chest and lumbar spine are the most common sites of pain localization, with 38% of patients having two or more anatomically

Pharmacological treatment

The current cancer pain management is based on the WHO recommendations which suggests a stepwise approach to the use of analgesic drugs. These recommendations provide a framework of principles rather than a rigid protocol. Although the feasibility and efficacy of the analgesic ladder has been reported in different studies, undertreatment of cancer pain persists despite efforts to provide clinicians with information about the use of analgesics [18]. Studies validating the WHO analgesic ladder

Spinal route

A small number of patients may still fail to obtain adequate analgesia despite large systemic opioid doses, or they may suffer from uncontrollable side effects such as nausea, vomiting, or oversedation. These patients may be candidates for the administration of a combination of opioids, local anesthetics, and clonidine via the spinal (epidural or intrathecal) route [33]. The goal of spinal opioid therapy is to place a small dose of an opioid and/or local anesthetic close to the spinal opioid

Conclusion

Pain associated with lung cancer is characterized by multiple expressions, due to either the progression of disease and/or induced by oncological treatment. An adequate assessment is required to plan a successful treatment. The oral route of opioid delivery should be the first choice. If the oral route cannot be used because of gastrointestinal obstruction and/or severe nausea/vomiting, the rectal is equivalent, although unsuitable for prolonged use. Another noninvasive alternative to the oral

Conflict of interest statement

No conflict of interest exists.

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