PROBLEM OF CHRONIC PAIN IN ONCOLOGY AND APPROACHES TO ITS RELIEF

This article reviews modern ideas about the pathogenesis of chronic pain in cancer patients and describes main approaches to its relief. Special attention is focused on factors important for the development of a patient-specific approach to the pathophysiology and management of chronic pain syndrome. These factors include genetics, gender, age, early anamnesis, patients’ immunological and endocrine status, as well as those shedding light on the pathogenetic aspects of chronic pain thus facilitating the choice of an optimal therapeutic approach. The review identifies limitations of pharmacotherapy as the major method of chronic pain management and justifies the need for alternative approaches. The latter include monitoring of the circadian rhythms of pain and various nonspecific effects, such as physical factors, psychological methods or reflex therapy. The experience and possibilities of non–pharmacological methods in the complex pathogenetic therapy of chronic pain are analysed, along with preventive measures permitting the development of chronic pain to be avoided. The pathological disorganizing and stressful role of chronic pain is considered with regard to the theory of functional systems. The pathogenetic significance of chronic pain in carcinogenesis and cancer progression is illustrated by examples from scientific literature. The authors emphasize the necessity of effective pain prevention, including invasive methods, in order to ensure an acceptable quality of life for cancer patients at any stage of the malignant process.