Costantino Benedetti, MD

The Pharmacologic Managementof Cancer Pain” by NathanCherny is an excellent, comprehensive,yet concise paper on thetreatment of cancer pain. It even goesbeyond its stated intention of discussingpharmacologic treatment, as it ventures-in a very appropriate, balanced,and succinct manner-to delve intothe issues of psychological therapiesand physiatric and invasive analgesictechniques.

Advanced cancer is associated with symptomsthat negatively affect the quality of life of patientsand their families. One significant effect is thechange cancer evokes in the nociceptive system. Thepatient's pain threshold may change to the pointwhere stimuli not previously considered painful (eg,touching, coughing, and walking) are now perceivedas painful, and painful stimuli evoke an exaggeratedperception of pain. About 75% of patients withadvanced cancer experience moderate to severe pain.