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Review
. 2024 May;63(5):497-506.
doi: 10.1007/s00120-024-02347-x.

[Pharmacological pain management in cancer patients]

[Article in German]
Anke Mütherig  1   2 , Gesine Scheffler  3 , Ulrich S Schuler  4   5
Affiliations
Review

[Pharmacological pain management in cancer patients]

[Article in German]
Anke Mütherig et al. Urologie. 2024 May.

Abstract
in English, German

Pharmacological pain therapy in cancer patients is based on guideline recommendations, which, however, do not fully coincide in all aspects due to varying weighting of evidence. The present article discusses current issues including the decreasing significance of the World Health Organization (WHO) analgesic ladder, with its distinction between step 2 and 3 being increasingly questioned. Risks of nonopioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in older populations, are discussed. Paracetamol may potentially reduce the effectiveness of immunotherapies. Aspects of administering analgesics via a feeding tube are considered. Recommendations for the treatment of episodic pain, transitioning between different opioids, and some relevant interactions are also discussed.

Die medikamentöse Schmerztherapie bei Tumorerkrankungen basiert auf Leitlinienempfehlungen, die bei unterschiedlicher Gewichtung der Evidenz nicht in allen Punkten übereinstimmen. Der vorliegende Beitrag diskutiert aktuelle Fragen, unter anderem die abnehmende Bedeutung des Stufenschemas der Weltgesundheitsorganisation (WHO), dessen Unterscheidung zwischen Stufe 2 und 3 zunehmend hinterfragt wird. Risiken von Nichtopioidanalgetika wie Paracetamol und nichtsteroidalen Antirheumatika, insbesondere in älteren Populationen, werden diskutiert. Paracetamol kann eventuell die Wirksamkeit von Immuntherapien vermindern. Es werden Überlegungen zur Schmerztherapie via Sonde angestellt. Empfehlungen zur Behandlung episodischer Schmerzen und zur Umstellung zwischen verschiedenen Opioiden sowie einige relevante Wechselwirkungen werden besprochen.

Keywords: Acetaminophen; Analgesics, opioid; Cancer pain; Cannabinoids; Morphine.

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References

Literatur

    1. AWMF (2020) Erweiterte S3-Leitlinie Palliativmedizin für Patienten mit einer nicht-heilbaren Krebserkrankung – Langversion 2.2. https://register.awmf.org/de/leitlinien/detail/128-001OL
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