A Cancer Pain Tutorial

A Comprehensive Visual Short Course
on Cancer Pain Management

Adjuvant Agents
Adjuvant agents enhance analgesic efficacy and allow for the treatment of concurrent symptoms. These agents also provide analgesia for specific types of pain, particularly neuropathic pain.
Corticosteriods
2D Model
thanks to: ChemFinder,
MDL and Structure Searcher

Clinical
Information

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Corticosteroids are useful because their anti-inflammatory activity reduces nociceptive pain.

They provide appetite stimulation, antiemetic activity, mood elevation and reduce cerebral and spinal cord edema.

These agents are useful for emergencies of elevated intracranial pressure and epidural spinal cord compression.

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Anticonvulsants

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Anticonvulsant are used to manage neuropathic pain, especially lancinating or burning pain. Three most common agents are listed here.

Dosage

Begin at lower doses and increase every 3-4 days to desired effect or toxicity.

Toxicity

  • carbamazepine (Tegretol) Bone marrow suppression; Sedation
  • phenytoin (Dilantin) Sedation
  • clonazepam (Klonapin) Sedation

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Antidepressants



Amitriptyline Properties

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Antidepressants

Antidepressants are useful for neuropathic pain. These agents have innate analgesic properties that may potentiate the analgesic effect of opioids. Commonly used Tricyclic antidepressants are listed here

  • amitriptyline (Elavil)
  • doxepin
  • imipramine (Tofranil)

Dosage

Begin at lower doses and increase slowly to desired effect or toxicity.

Toxicity

Sedation 

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Desipramine Properties

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Local Anesthetics

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 Local anesthetics have been used to treat neuropathic pain but side effects of therapy frequently limit their use. Most common agents used are listed here:
  • mexiletine (Mexitil)
  • tocainide (Tonocard)

Toxicity :

Nausea, Vomiting, Dizziness

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Psychostimulants

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 Psychostimulants may be useful in reducing opioid induced sedation Most commonly used drugs are listed here:
  • methylphenidate (Ritalin)
  • dextroamphetamine (Dexedrine)

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Miscellaneous

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Ca++
channel
blocker
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Note 0: Only drugs that are FDA approved as an analgesic for use in children are included.
Note 1: Acetaminophen and NSAID dosages for adults weighing less than 50 kg should be adjusted for weight.
Note 2: Relative Potency may be viewed as how the a particular substance, rendered in blue, "stacks up" in potency against a morphine standard, rendered in red.
Note 3: Asingle unadorned letter "h" is the standard metric abbreviation for hour, "kg" is the abbreviation for kilogram.
Note 4: Ref: Source of Dosage Guidelines Roxanne Laboratories Pain Institute
Note 5: You can modify these drug structures and search for the resulting compound using this plug-in.