A Guide for Cancer Pain Management in Latin America

Cancer prevalence in Latin America (LATAM) is increasing and represents a major cause of morbidity and mortality. Managing cancer patients—who live longer than ever before—requires appropriate management of cancer pain, described by the World Health Organization (WHO) in 1988 with its now famous “pain ladder,” the rungs of which represented nonopioids, weak opioids, and strong opioids as pain relievers. Yet even today much cancer pain is undertreated. Cancer pain can be multimechanistic with a neuropathic component which may complicate pain control. Acute pain should be treated aggressively to avoid the potential transition to chronic pain, a maladaptive form of pain that can be particularly challenging to treat. Although opioids have been recognized by WHO in 1988 and since then as a safe, effective form for treating moderate to severe cancer pain, opioid consumption in LATAM nations is very low. LATAM countries make up about 9% of the world’s population but represent only about 1% of global opioid consumption. Better education about pain control in cancer and opioid therapy is needed by both healthcare providers and patients to better treat cancer pain in LATAM. But opioid-associated side effects and the risk of abuse and diversion are important risks of opioid therapy that are to be fully understood by both healthcare providers and patients before commencing therapy. Opioid risk management plans balance the need for access to opioids for appropriate patients with the mitigation of opioid-related risks of abuse and addiction. Risks as well as benefits should be clearly understood in order to consider opioid therapy. Combining education, prescription drug monitoring plans, and other risk mitigation strategies may be useful tools. Abuse-deterrent formulations, such as fixed-dose combination products of an opioid with naloxone, have been designed to resist abuse. LATAM may benefit from such new products in efforts to bring better pain control to cancer patients in a rational and responsible manner.