Recent advances in pharmacotherapy for cancer pain management.

PURPOSE: This review provides an outline of several recent advances in drug treatment options and strategies for managing cancer pain. OVERVIEW: The development of cyclooxygenase-2-selective nonsteroidal anti-inflammatory drugs (NSAIDs) and transmucosal fentanyl citrate provide new pharmacologic options for the treatment of cancer pain. Combinations of opioid agonists and antagonists have provided data on new strategies to balance effective analgesia with analgesic-related adverse effects. In addition, the spectrum of adjuvant agents for the treatment of neuropathic pain has been extended to various antidepressants and topical analgesics. There is continued research on the role of the N-methyl-d-aspartate (NMDA) receptor and, specifically, on NMDA receptor antagonists that may augment analgesia and combat opioid resistance. Finally, a more potent generation of bisphosphonates may lead to improved pain relief for patients with bone metastases. CLINICAL IMPLICATIONS: With a combination of emerging new clinical research and professional practice experience of the cancer care team, new strategies will continue to be developed and implemented, resulting in the continued improved care of patients with cancer.