Therapie tumorassoziierter Schmerzen – von medikamentös bis invasiv

Depending on the stage of the tumor up to 80% of the patients suffer from cancer-related pain but treatment is often inadequate. Multiple causes can trigger pain and these can be due to the tumor itself, its secondary consequences but also treatment related. A differentiated assessment and individually tailored treatment of cancer-related pain not only improve the quality of life but also reduce the risk of pain chronification. A differentiation between nociceptive pain and pain caused by hypersensitivity is a mandatory requirement for adequate pharmacotherapy. There is a risk of inadequate pain control, particularly with a lack of consideration and treatment of hypersensitivity, e.g., with anticonvulsants or analgesic antidepressants. Opioids are an integral part of drug treatment for cancer-related pain and especially for the treatment of breakthrough cancer pain. The risk of abuse should be considered. Other substance groups are suitable for special pain situations or in cases refractory to treatment. Nonpharmacological treatment options should also be considered, in particular by offering low-threshold access to psychotherapeutic or psycho-oncological options. Invasive procedures can be a useful supplement. These range from patient-controlled subcutaneous or intravenous infusion pump systems and intrathecal drug administration up to neurolytic and ablative procedures. Due to the invasiveness of these procedures, an interdisciplinary approach is recommended to confirm the indications.