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Executive Summary

WHO PROPOSED CANCER PAIN RELIEF GUIDELINES STRESS ORAL ANALGESIC USE under a "three-step ladder" approach, whereby drugs increase in strength from aspirin to codeine and finally to morphine, the U.N. agency explained in background material distributed at a Sept. 5 gathering in Washington, D.C. The meeting assembled representatives from foreign governments, private foundations and the pharmaceutical industry to consider project proposals aimed at giving educational and financial support to the World Health Organization's cancer pain relief program. "Drugs are the mainstay of cancer pain management," WHO emphasized. "If used correctly -- the right drug in the right dose at the right time interval -- they are effective in a high percentage of patients." According to the results of studies conducted in Japan and Italy, complete relief of pain was reported in 70-87% of cancer patients. "The drugs increase in strength from non-opioids (aspirin or acetaminophen) to mild (codeine) and then to strong (morphine) opioids until the patient is free from pain -- hence the concept of an 'analgesic ladder,'" WHO explained. "The drugs are not given 'as required' only at time of pain, which is the general practice, but every four to six hours 'by the clock.'" The guidelines note that adjuvant drugs, for example certain anticonvulsants, psychotropics and steroids, can be used under certain conditions. WHO statistics derived from studies in the U.S. and the U.K. indicate that moderate to severe pain occurs in 30-40% of patients with early cancers and in 45-100% of patients with advanced cancers, and that pain is inadequately managed in 20-40% of cases. Approximately six million new cases of cancer are diagnosed worldwide each year, about half in Third World nations, WHO maintained. "Treatment of pain is generally neglected worldwide," WHO emphasized. Obstacles to proper treatment that were cited include patient and physician lack of awareness that pain can be relieved, patient acceptance of pain, fear of drug addiction, underprescribing and underdosing by the profession, wrong timing of the drugs given, lack of education of health care professionals, poor drug supply and inadequate drug legislation. With the expressed goal of "Freedom from Cancer Pain," the WHO program calls for: the establishment of a global network to disseminate Knowledge of what can be done to relieve pain; the incorporation of cancer pain therapy into the training of doctors and nurses; the development of cancer pain relief fully in standard cancer textbooks; the treatment of cancer pain in general hospitals, health centers and homes, rather than only in specialized cancer centers; the reframing of national drug legislation in ways that do not hinder pain-relieving medication from reaching patients; and the raising of extra-budgetary funds, both private and public, to support local and national programs of pain therapy.

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