In men with advanced prostate cancer what palliative interventions (including use of analgesics and co-analgesics) can assist in pain control?
No randomised controlled trials dealing specifically with analgesia for prostate cancer patients were found. However a vast literature dealing with analgesic treatments for cancer pain was identified. A systematic review of this literature was beyond the scope of these guidelines. As a result it was not possible to develop specific recommendations for this question. There are consensus recommendations regarding cancer pain management based on best available evidence. The recommendations highlight the importance of routine screening for the presence or absence of pain, followed by comprehensive pain assessment if pain is present.
Depending on pain severity and type, there is support for the use of non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol for bone pain, with titration of opioids if required. The importance of breakthrough opioid dosing for patients on long-acting opioids, and the concurrent use of laxatives, is also emphasised.
Neuropathic pain may require a different approach, with the early use of tricyclic antidepressants and anti-convulsants as well as possible use of steroids.
Concurrent use of palliative radiotherapy, where appropriate, is highlighted, but the role of bisphosphonates in prostate cancer pain management remains uncertain (Refer to Evidence for the use of bisphosphonates in the prevention of skeletal events and Evidence for the use of bisphosphonates in the treatement of bone pain). Following successful use of radiotherapy to control pain, analgesic regimens may require re-adjusting with continuing regular reassessment to reduce opioid use and prevent opioid accumulation and potentiation of opioid side-effects.
- Dy SM, Asch SM, Naeim A, Sanati H, Walling A, Lorenz KA. Evidence-based standards for cancer pain management. J Clin Oncol 2008 Aug 10;26(23):3879-85 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18688056.
- Swarm R, Anghelescu DL, Benedetti C, Boston B, Cleeland C, et al. Adult cancer pain. J Natl Compr Canc Netw 2007 Sep 1;5(8):726-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17927930.