1998 issue 1


Volume 7, issue 1

Ból i jego znaczenie

The pathological mechanisms and treatment principles in pain caused by malignant neoplasms

1. Kliniki Opieki Paliatywnej przy Katedrze Onkologii AM w Poznaniu
Postępy Psychiatrii i Neurologii, 1998, 7, 39-52
Keywords: pain of neoplastic origin, nociception, neuropathic pain, non-opioid and opioid analgesics, analgesics adjuvants


The introduction of WHO principles for the treatment of pain caused by malignant neoplasms in the network of palliative care centres and hospice developed also in Poland, with the cooperation of pain treatment clinics and leading oncology centres has brought an improvement in the care of patients with advanced malignant neoplasms. An important role in this was the introduction for therapy of the most effective analgesic – morphine in oral form (or subcutaneously in case of vomiting or dysphagia). Its introduction was associated with tearing off of the myths about the dependence, euphorising and respiratory depression causing effects of that opiate. The advances in the knowledge of the pathological mechanisms of pain in malignant neoplasms, in pharmacokinetics and pharmacodynamics of analgesics have led to synthesis of new safe drugs (inhibitors of COX-2), tramadol has replaced codeine known to produce constipation, and oral preparations of tramadol and morphine with long-acting controlled effects, as well as percutaneous fentanyl have been evolved for dealing with pain resistant to morphine in about 5% of patients, such as opioid rotation, subarachnoid or extrathecal analgesia, addition of ketamine (an antagonist of NMDA receptor) in subanaesthetic doses, or in exceptional situations – controlled sedation in place of invasive method of pain treatment, often with low effectiveness and fraught with complication risk.

Address for correspondence:
Prof. Jacek Łuczak,
Klinika Opieki Paliatywnej
przy Katedrze Onkologii AM,
ul. Łąkowa 1/2, 61-878 Poznań