Page 164 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Cancer pain

VetBooks.ir and proposed utility of the pain management
In human medicine, despite the popularity
pain
ladder, few controlled clinical trials have been
It is now clear that virtually every tumour mass performed to support its e ectiveness in
contains both neoplastic cells and immune managing cancer pain ech, 99 . In veterinary
cells present in varying densities. Rather than patients, it therefore forms part of a structured
re ecting an attempt by the immune system to approach to the problem of cancer associated
eradicate the tumour, there is increasing pain; however, there are several important
evidence that these cells and associated considerations and limitations
in ammation provide vital support to tumour ■ i culty in establishing the e cacy and
development and progression. In fact, tumour safety of individual analgesic medications
associated in ammation has recently been within and between species
designated as a tumour enabling characteristic ■ i culty in establishing e ective dosing of
anahan and einberg, 11 . his may human medications in veterinary species
explain why tumours may develop at sites of ■ Speci c toxicities of medications in
chronic in ammation. veterinary species, e.g. paracetamol can
he presence of immune cells in the never be given to cats
tumour mass and microenvironment provides ■ i culties in drug dosing due to failure of
compelling evidence for the association of owner or patient compliance; in particular,
neoplastic growth and relevant in ammatory issues of drug palatability for oral dosing,
pain. his suggests widespread bene ts of which may be re uired long term
anti in ammatory medications in both cancer ■ Reformulation of medications or use of
pain management and potentially in the control li uid preparations may be useful for
of tumour progression.
smaller patients
Treatment of cancer-associated ■ here are legal guidelines established by
pain the drug Prescribing Cascade and the use
of non licensed medications is not
he goal of pain management is to provide encouraged
symptom relief and improve an individual s ■ Consideration of possible drug interactions
level of functioning in daily activities and or treatment related side e ects, especially
therefore oL. his is achieved in the if a patient is receiving chemotherapy. or
following ways example, certain tumours respond well to
treatment with corticosteroids, ruling out
■ reatment of the tumour concurrent use of non steroidal anti
■ Provision of analgesia in ammatory drugs NSAI s
■ Use of complementary methods for ■ Consideration of the most appropriate
palliative care. analgesic for an individual s cancer type
rather than always following a step wise
It is beyond the scope of this chapter to approach
describe treatment of speci c tumour types ■ any dogs and cats are presented with
and therefore we shall focus on provision of advanced cancer and therefore may be
analgesia and complementary care. experiencing chronic pain at the time of
In 9 , the orld ealth rgani ation initial presentation. Speci c medications
introduced a three step analgesic ladder that may be more suited to the management of
has been widely accepted in human cancer pain chronic pain.
management see Appendix . Broadly
speaking, as the intensity of pain increases, hroughout this book, speci c descriptions
patients are moved progressively higher on of drugs are provided listed in various classes,
the ladder. including dose rates in dogs and cats, which

159

Ch7H Pain Management.indd 159 19/12/2018 10:46