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Title: Cancer pain and the World Health Organization analgesic ladder
Author: Reid, Colette Mary
ISNI:       0000 0001 3512 6322
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2007
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Introduction: This dissertation investigates the current management of cancer pain with particular emphasis on the World Health Organization analgesic ladder. This was considered necessary because published studies examining the adequacy of cancer pain control have suggested that the efficacy of the WHO ladder may have been overestimated and because the place of morphine as the 1st line opioid at Step III of the ladder has been challenged. The dissertation also investigates whether an alternative approach might be superior and further explores the patient barriers to the use of opioids. Methods: The studies incorporated within this dissertation include an observational pain study examining pain control in 242 patients under the care of specialist palliative care teams, a systematic review and meta-analysis of 4 trials investigating oxycodone in cancerrelated pain, a pilot study for a randomised controlled trial of an experimental 2-step analgesic ladder versus the traditional 3-step approach and a qualitative study exploring patients' views and concerns when offered opioids for the treatment of pain caused by cancer. Results: The observational study showed that pain was not well controlled for the majority (79.3%: C. I. 74.1% to 84.4%); the systematic review showed that there was no difference in efficacy and tolerability between oxycodone and morphine; and the 2-step trial showed that earlier use of Step III opioids within the novel 2-step approach might result in better pain control. However, the qualitative study showed that patients associate morphine and other Step III opioids with death and therefore they reject them as useful means of controlling pain. Conclusion: Morphine and other opioids currently remain our best means of managing pain caused by cancer, but that both professionals and patients require ongoing education, so that we can break down the barriers that still inhibit their use.
Supervisor: Forbes, Karen Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available