Pharmacologic management of cancer pain in rural Minnesota

Use of analgesic medications for cancer pain was assessed in six Minnesota communities. In our survey, cancer patients were treated primarily by family practice physicians. Approximately 70% were given one or more analgesics; 84% received a nonsteroidal antiinflammatory drug and 73% received an opioid. Most patients given an antiinflammatory drug received less than the maximal recommended dose for the drug. The most common opioid for cancer pain was oral morphine. Approximately 40% of the patients treated with opioids took the drug only when needed; the remainder took the drug around-the-clock, with or without additional opioids for breakthrough pain. Only 14% of patients who received analgesics received a coanalgesic and only 13% received a nonanalgesic adjuvant. The patterns of analgesic use in these communities corresponded well with accepted principles of cancer pain management: liberal use of opioids, use of oral morphine as the predominant agent, and avoidance of meperidine and opioid agonist/antagonist.