TABLE 1-3 Symptom Control Research Opportunities and Unmet Needs

Symptom

Basic

Clinical or Health Services

Pain

• Elucidate basic mechanisms of visceral and neuropathic pain; identify new treatments

• Identify modifications of nervous system involved in chronic pain perception

• Find new compounds with more precise analgesic action and fewer side effects

• Find molecular basis of pain signaling, receptor modification due to pain, and ways to modify

• Identify forebrain structures that modulate responses to “painful” signals

• Determine receptor affinities of different opioids

• Determine why so many patients have poorly controlled pain

• Study ways to improve cancer pain management

• Determine effectiveness of treatments for neuropathic pain

• Determine effects of cancer on tolerance to opioid analgesics and how pain can be managed in already tolerant patients

• Determine side-effect profiles of different opioids

• Conduct trials of intrathecal delivery of novel analgesics

Anorexia or Cachexia

• Elucidate roles for various cytokines in cachexia

• Elucidate roles of food regulatory peptides in cachexia

Conduct clinical trials of

• Proinflammatory mediators

• Appetite stimulants

• Anticatabolic agents (e.g., neuropeptide agonists or antagonists, beta2-adrenoceptor agonists)

• Polyunsaturated fatty acids, n-3 fatty acids, fish oil

• Anabolic agents (especially hormonal)

• Anticytokines (e.g., megestrol acetate, medroxyprogesterone acetate, thalidomide, melatonin)

Cognitive failure: delirium, temporary and permanent cognitive impairment

• Elucidate underlying mechanisms of delirium and cognitive impairment

• Identify role of cancer disease process in cognitive impairment

• Determine how biological therapies (e.g., interferon alpha, interleukin-2) produce cognitive impairment

• Find biological markers for patients most at risk of

• Develop standardized assessment for delirium

• Determine prevalence, nature, and current treatments for delirium and cognitive impairment

• Conduct clinical trials of

– Drugs used empirically for delirium (haloperidol) and cognitive impairment (methylphenidate)

– stimulants for cognitive



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