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open access
The practical use of the WHO analgesic ladder has evolved
over time; is there a need for a formal change? Taking into
consideration
that pain is the symptom most feared by patients and
families, and that studies have demonstrated that 90% of patients with
cancer experience pain1 and only 50% receive adequate pain control in unselected cancer cohorts,2
there is an urgent need for improvement. The solutions are clearly more
complex than simply changing the WHO analgesic ladder.
Systematic pain diagnosis during oncology
consultations should be incorporated as a minimum requirement into
standard inpatient
and outpatient consultations. However, it is debatable
how to address symptom management in general and pain management
specifically
in consultations where the primary focus is often how
to treat the tumor and prolong life. Cancer pain is affected by many
variables, such as tumor type and site, the extent of
the disease, cancer therapy, and host factors (sex, genomics, and
psychologic
and social factors, among others), which challenge a
simple solution to pain diagnosis. Is it possible to simplify both pain
classification and management, with improved overall
pain control as a result?
In the article that accompanies this editorial, Bandieri et al3 challenge the concept of the WHO analgesic ladder.....-
See accompanying article on page 436
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