Cancer pain

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released May 19, 2000; last updated May 2, 2017; expires May 2, 2020

Overview

Pain is a common, undertreated problem in cancer patients. The ideal management of a patient with cancer pain is a multidisciplinary approach that includes oncology, neurology, anesthesia, nursing, psychology, and pharmacy. Opioids remain the cornerstone of pharmacotherapy for cancer pain, and various factors taken into consideration for the selection of an opioid include the severity of pain, the patient's response to previous therapy, the drug's pharmacokinetics, and the available formulations. In the following article, the author reviews the evaluation of pain as a symptom of cancer and discusses the pathophysiology, assessment, differential diagnosis, diagnostic workup, and general management of the condition.

Key points

 

• Cancer pain is frequent and often undertreated.

 

• The mainstay of breakthrough pain in cancer is use of adequate opioids with improved delivery.

 

• Approximately 10% to 30% of patients with cancer pain require surgery, which may be directed at the cancer or may involve neurosurgical procedures for relief of pain.

Historical note and terminology

Pain is experienced by as many as 90% of the patients with advanced cancer sometime in the course of their disease. It is generally known that cancer pain is undertreated, the most common cause being inadequate assessment. Cancer pain may be acute or chronic and the latter may be neuropathic. The focus of this article is the evaluation of pain as a symptom of cancer with discussion of pathophysiology, assessment, differential diagnosis, diagnostic workup, and general management.

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