Pharmacological strategies for the management of cancer pain in developing countries

  • Afekhide E. Omoti
  • Caroline E. Omoti
Keywords: Pain, Neoplasms, Analgesics


Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy.  There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given ‘by the ladder,’ ‘by the clock’ and ‘by the appropriate route’ using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed.


Download data is not yet available.


1. Brasseur L. Review of current pharmacologic treatment of pain. Drugs 1997; 53 Suppl 2:10-7.

2. Bressler L. Pain management in cancer patients. (1997).

3. Carr DB, Goudas LC, Balk EM, Bloch R, Ioannidis JP, Lau J. Evidence report on the treatment of pain in cancer patients. J Natl Cancer Inst Monogr 2004; (32): 23-31.

4. Caimi P, Cymet TC. As if the cancer wasn’t enough: understanding and treating the pain that comes with cancer. Compr Ther 2006; 32(3): 176-81.

5. Cherny NI, Portenoy RK. The management of cancer pain. CA Cancer J Clin 1994; 44(5): 263-303.

6. Cherny NI, Portenoy RK. Cancer pain management. Current strategy. Cancer 1993; 72(11 Suppl): 3393-415.

7. Omoti AE, Waziri-Erameh MJM. Compliance with medical therapy in patients with primary open angle glaucoma. Journal of Medicine and Biomedical Research 2003; 2(1):46-53.

8. Omoti AE, Ukponmwan CU. Compliance with new drugs in glaucoma therapy in Benin City, Nigeria. Seguimiento Farmacoterapeutico 2005; 3(3): 135-43.

9. Amoni SS. Changes of glaucoma in Africa. Nigerian Journal of Ophthalmology 1997; 5:56-9.

10. Omoti CE, Agada LO. Compliance with chemotherapy in adult leukaemia patients in Benin City, Nigeria. Seguimiento Farmacoterapeutico 2005; 3(1): 1-9.

11. Besson JM. The complexity of physiopharmacologic aspects of pain. Drugs 1997; 53 Suppl 2: 1-9.

12. The management of chronic pain in patients with breast cancer. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Society of Palliative Care Physicians. Canadian Association of Radiation Oncologists. CMAJ 1998; 158 Suppl 3: S71-81.

13. Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? J Clin Oncol 1998; 16(10): 3216-21.

14. Chiarini L, Stacca R, Bertoldi C et al. Mnangement of facial pain resulting from cancer in oral and maxillofacial surgery. Minerva Stomatol 1997; 46(1-2): 27-38.

15. Schumacher MA, Basbaum AI, Way WL. Opioid analgesics and antagonists. In: Katzung BG (ed). Basic and Clinical Pharmacology. 9th ed. The McGraw-Hill Companies, Boston, 2004:497-516.

16. Soares LG. Methadone for cancer pain: what have we learned from clinical studies? Am J Hosp Palliat Care 2005; 22(3): 223-7.

17. Vallerand AH. The use of long-acting opioids in chronic pain management. Nurs Clin North Am 2003; 38(3): 435-45.

18. Cherny NI, Foley KM. Current approaches to the management of cancer pain: a review. Ann Acad Med Singapore 1994; 23(2): 139-59.

19. Bruera E, Willey JS, Ewert-Flannagan PA, Cline MK, Kaur G, Shen L, Zhang T, Palmer JL. Pain intensity assessment by bedside nurses and palliative care consultants: a retrospective study. Support Care Cancer 2005;13(4):228-31.

20. Anderson KO, Richman SP, Hurley J et al. Cancer pain management among undeserved minority patients: perceived needs and barriers to optimal control. Cancer 2002; 94(8): 2295-304.

21. Miaskowski C, Dodd MJ, West C et al. Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning. Gerontologist 2002; 42(2): 507-14.

22. Levy MH, Samuel TA. Management of cancer pain. Semin Oncol 2005; 32(2): 179-93.

23. Cherny NI. The pharmacologic management of cancer pain. Oncology (Williston Park) 2004; 18(12): 1499-515.

24. McDonnell FJ, Sloan JW, Hamann SR. Advances in cancer pain management. Curr Oncol Rep 2000; 2(4): 351-7.

25. Mancini I, Body JJ. Treatment of cancer pain: the role of co-analgesics. Rev Med Brux 1998; 19(4): A319-22.

26. Morimoto M. Adjuvant analgesics in cancer pain: clinical pharmacology and efficacy. Nippon Rinsho 2001; 59(9): 1806-11.

27. McNicol E, Strassels SA, Goudas L, Lau J, Carr DB. NSAIDS or paracetamol, alone or combined with opioids for cancer pain. Cochrane Database Syst Rev 2005;(1): CD005180.

28. Dohi S. Non-opioid analgesics in cancer pain. Nippon Rinsho 2001; 59(9): 1800-5.

29. McNicol E, Strassels SA, Goudas L, Lau J, Carr DB. Nonsteroidal anti-inflammatory drugs, alone or combined with opioids, for cancer pain: a systematic review. J Clin Oncol 2004; 22(10): 1975-92.

30. Eisenberg E, Berkey CS, Carr DB, Mosteller F, Chalmers TC. Efficacy and safety of nonsteroidal anti-inflammatory drugs for cancer pain: a meta-analysis. J Clin Oncol 1994; 12(12): 2756-65.

31. Hoskin PJ, Hanks GW. Opioid agonist-antagonist drugs in acute and chronic pain states. Drugs 1991; 41(3): 326-44.

32. Wiffen PJ, Edwards JE, Barden J, McQuay HJ. Oral morphine for cancer pain. Cochrane Database Syst Rev 2003; (4): CD003868.

33. Mancini I, Lossignol DA, Body JJ. Opioid switch to oral methadone in cancer pain. Curr Opin Oncol 2000; 12(4): 308-13.

34. Bruera E, Palmer JL, Bosnjak S et al. Methadone versus morphine as a first-line strong opioids for cancer pain: a randomized, double-blind study. J Clin Oncol 2004; 22(1): 185-92.

35. Mercadante S, Casuccio A, Agnello A, Serretta R, Calderone L, Barresi L. Morphine versus methadone in the pain treatment of advanced-cancer patients followed up at home. J Clin Oncol 1998; 16(11): 3656-61.

36. Mercadante S, Bianchi M, Villari P et al. Opioid plasma concentration during switching from morphine to methadone: preliminary data. Support Care Cancer 2003; 11(5): 326-31.

37. Mercadante S, Casuccio A, Calderone L. Rapid switching from morphine to methadone in cancer patients with poor response to morphine. J Clin Oncol 1999; 17(10): 3307-12.

38. Zeppetella G, Ribeiro MD. Opioids for the management of breakthrough (episodic) pain in cancer patients. Cochrane Database Syst Rev 2006; (1):CD004311.

39. Farrar JT, Cleary J, Rauck R, Busch M, Nordbrock E. Oral transmucosal fentanyl citrate: randomized, double-blinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients. J Natl Cancer Inst 1998; 90(8): 611-6.

40. Portenoy RK, Payne R, Coluzzi P et al. Oral transmucosal fentanyl (OTFC) for the treatment of breakthrough pain in cancer patients: a controlled dose titration study. Pain 1999; 79(2-3): 303-12.

41. Payne R, Coluzzi P, Hart L et al. Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. J Pain Symptom Manage 2001; 22(1): 575-83.

42. Sittl R, Griessinger N, Likar R. Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders: a multicenter, randomized, double-blind, placebo-controlled trial. Clin Ther 2003; 25(1): 150-68.

43. Likar R, Kayser H, Sittl R. Long term management of chronic pain with transdermal buprenorphine: a multicenter, open-label, follow-up study in patients from three short-term clinical trials. Clin Ther 2006; 28(6): 943-52.

44. Bono AV, Cuffari S. Effectiveness and tolerance of tramadol in cancer pain. A comparative study with respect to buprenorphine. Drugs 1997; 53 Suppl 2: 40-9.

45. Dayer P, Desmeules J, Collart L. Pharmacology of tramadol. Drugs 1997; 53 Suppl 2: 18-24. Drugs 1997; 53 Suppl 2: 18-24.

46. Keskinbora K, Aydinli I. An atypical opioids analgesic: tramadol. Agri 2006; 18(1): 5-19.

47. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43(13): 879-923.

48. Ripamonti C, Dickerson ED. Strategies for the treatment of cancer pain in the new millennium. Drugs 2001; 61(7): 955-77.

Most read articles by the same author(s)