NYERI KANKER

Beberapa tipe nyeri kanker

Acute Pain
Somatic Pain (Konstan, sakit-sakitan, mudah di lokalisasi)
Contoh
: Metastase tulang, soft tisue tumor
Mekanisme
: aktivasi nociceptors, mengeluarkan substasi analgesik (khususnya
prostaglandins)
Manajemen
: Aspirin, Asetaminopen, NSAID
Visceral Pain (constant, tumpul atau dalam, sulit dilokalisasi, biasanya dengan mual dan
muntah, sering seperti kolik atau kram)
Mekanisme
: Aktivasi nosiseptor
Contoh : Kanker pangkreas, metastasis hati / paru dengan nyeri dibahu
Manajemen
: - NSID, Opioid (MS contin )
- Nerve block (e.g celiac plexus block)

Chronic Pain
NeurophaticPain (burning pain, paroxysmal shooting or electrical shock-like pain)
Mekanisme
: - Spontaneus discharges of peripheral or central n.s.
- Loss of central inhibition
Contoh
: - Post herpetic neuralgia,
- Metastasis brachial atau lumbosacral plexo-pathies
Manajenen : - Anti depressant atau antikonvulsi
- Nerve block, dan lain-lain.

WHO Analgesic Ladder

STEP 3
Strong opioid
+nonopioid
+ adjuvant

STEP I
NSAIDs may delay the need for escalating opioid doses or the use of lower doses
Recent report, NSAIDs were suspended due to adverse effects in minority cases and
approximately 20% of patients were still taking NSAIDs in the last week of life
NSAIDs have been shown to have a relevant opioid-sparing effect
Caution is also needed when using NSAIDs for prolonged periods
Risk factors such as aging, renal or gastrointestinal diseases, hypovolemia or
concomitant use of drugs should be considered
STEP II
The role of opioids in the treatment of moderate cancer pain has been questioned
recently

It has been speculated that this step could be bypassed

STEP III
Oral morphine is the mainstay of moderate to severe cancer pain
MS contin is one of chance since:
o Simple
o Effective
NON OPIOID ANALGESICS :
Usual analgesics: Aspirin, Acetominophen
NSAIDs ( Non-selective COX Inhibitors ) :Ibuprofen, Ketoprofen, Naproxen, Diclofenac
Sodium, Indomethacin, Ketorolac, Piroxicam, Mefenamic acid
NSAIDs ( Selective COX-2 Inhibitors ): Celecoxib, Parecoxib, Rofecoxib, etc.
Opioids for Moderate Pain
Weak Opioid
Codein:- Usually used as antitussive.
- Constipation is the most common side effec
Opioids for Severe Pain

Morphine-Like Agonist
Morphine, Levorphanol, Codein, Hydromorphine, Methadone, Oxycodone, Fentanyl
transdermal, Meperidine

Partial Agonist
Buprenorphine

Mixed Agonist Antagonist

Pentazocine,Nalbuphine,Butorphanol
Adjuvant Drugs
Corticosteroids : Dexamethasone, Prednison
Anticonvulsant : Carbamazepine, Gabapentin, etc
Antidepressant : Amytriptiline, Doxepine
Neuroleptics : Methotrimeprazine
Antihistamines : Hydroxyzine
Local anesthetic/antiarrhytmics : Lidocaine
Psycho-stimulans : Dextroamphetamine
Laxatives : Bisacodyl, Lactulose, etc
Antiemetics : Droperidol, Metoclopropamide, etc

Formula in RSWS
Moderate pain
Acetaminophen / Aspirin
Codein
Dulcolax
mfpulvdtd XXX
6 dd I cap
06.00
18.00
10.00
22.00
14.00
02.00

500 mg
20 mg
tab

+ adjuvant

Severe pain
MST 5 - 10 mg
2 dd I tab
Celebrex 100200 mg
2 dd I cap
06.00 18.00
+ adjuvant

Alternatif pilihan untuk penanganan nyeri

Tramadol
Clonidine
Calcitonin
Accupuncture
Magnetic-field therapy
Fentanyl (oral, injectable, transmucosal )
TENS
DepoMorphine.