Relief of chronic cancer pain

image of Relief of chronic cancer pain
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In human medicine there is a significant amount of interest in cancer pain, both in its neurobiology and in novel methods to alleviate it. However, little is known about the relationship between pain and cancer in animals. This chapter looks at how common is cancer pain in dogs and cats?; the importance of alleviating pain; classification of cancer pain; assessment of cancer pain; an approach to cancer pain management; principles of drug therapy; the future: towards a mechanistic understanding of cancer pain.

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11.2 Peripheral and central sensitization and cancer pain. In the normal animal, noxious stimuli (red arrows) are transmitted via the spinal cord to the brain and perceived by the brain as painful. Non-noxious stimuli (blue arrows) travel through the system and are perceived by the brain as non-painful stimuli. A cancer that is associated with pain results in a barrage of sensory information going into the spinal cord in the area of the dorsal horn. Peripheral sensitization develops (see text for details), making it easier for a signal to get through and be perceived as painful (hyperalgesia). Also, usually innocuous stimuli are felt as painful (blue arrow into spinal cord becomes a red arrow to the brain). These changes are known as . Occasionally, after resolution of the initiating problem (e.g. amputation for limb osteosarcoma), behaviour indicative of pain remains or recurs. This may be due to the establishment of ‘pain generator’ centres. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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11.4 The WHO ‘analgesic ladder’ for the treatment of cancer pain.
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11.7 Decision-making tree for the treatment of cancer pain in cats and dogs. This should be considered as a guide only; approaches in individual patients will vary. For example, it may be most appropriate to initiate treatment of pain associated with osteosarcoma with an NSAID and palliative radiation before moving to other adjunctive drugs.
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