Defining refractory pain in cancer for clinicians and researchers

摘要

Clinicians in hospice and palliative care often criticize their oncological colleagues for offering off-label third-, fourth-, or fifth-line anticancer therapy with rapidly diminishing benefit and a relative shift in the therapeutic ratio towards toxicity. Oncologists often defend this action on the grounds that "there is nothing else to offer," In hospice and palliative care, we are at risk of similar behavior with the treatment of refractory pain unless there is an agreed taxonomy for the diagnosis which clinicians and researchers can operationalize uniformly.The multidimensional nature of pain, the absence of objective measures of response, and the palpable distress of severe pain all contribute particular challenges to clinicians who are intent on relieving suffering. Working toward better consistency of terminology is important for all symptoms when terms such as "refractory" are used.