Adult Cancer Pain

Authors: Robert Swarm MD, Amy Pickar Abernethy MD, Doralina L. Anghelescu MD, Costantino Benedetti MD, Craig D. Blinderman MD, MA, Barry Boston MD, Charles Cleeland PhD, Nessa Coyle PhD, NP, Oscar A. deLeon-Casasola MD, June G. Eilers PhD, APRN, Betty Ferrell RN, PhD, Nora A. Janjan MD, MPSA, MBA, Sloan Beth Karver MD, Michael H. Levy MD, PhD, Maureen Lynch MS, APRN, Natalie Moryl MD, Barbara A. Murphy MD, Suzanne A. Nesbit PharmD, BCPS, Linda Oakes RN, MSN, Eugenie A. Obbens MD, PhD, Judith A. Paice PhD, RN, Michael W. Rabow MD, Karen L. Syrjala PhD, Susan Urba MD and Sharon M. Weinstein MD
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Volume/Issue:
Volume 8: Issue 9
Online Publication Date:
Sep 2010
DOI:
https://doi.org/10.6004/jnccn.2010.0076
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OverviewPain, defined as “a sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage,”1 is one of the most common symptoms associated with cancer. Cancer pain or cancer-related pain is distinct from pain experienced by patients without malignancies. Pain occurs in approximately one quarter of patients with newly diagnosed malignancies, one third of patients undergoing treatment, and three quarters of patients with advanced disease,2–4 and is one of the symptoms patients fear most. Unrelieved pain denies patients comfort and greatly affects their activities, motivation, interactions with family and friends, and overall quality of life.The importance of relieving pain and availability of effective therapies make it imperative that physicians and nurses caring for these patients be adept at the assessment and treatment of cancer pain.5–7 This requires familiarity with the pathogenesis of cancer pain; pain assessment techniques; common barriers to the delivery of appropriate analgesia; and pertinent pharmacologic, anesthetic, neurosurgical, and behavioral approaches to the treatment of cancer pain.The most widely accepted algorithm for the treatment of cancer pain was developed by the WHO.8,9 It suggests that patients with pain be started on acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If this is not sufficient, patients should be escalated to a weak opioid, such as codeine, and then to a strong opioid, such as morphine. Although this algorithm has served as an excellent teaching tool, the management of cancer pain is considerably more complex than this 3-tiered “cancer pain ladder”...
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Copyright:
Copyright © 2010 by the National Comprehensive Cancer Network
Page Numbers:
1046–1086
Article Category:
Review Article
Print Publication Date:
01 Sep 2010
Online Publication Date:
Sep 2010
Keywords:
NCCN Clinical Practice Guidelines; NCCN Guidelines; cancer; pain; malignancy; pain assessment; pain intensity rating
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