Cancer pain assessment and management: survey

Cancer has a profound impact upon public health throughout the world due to its prevalence and devastating morbidity and mortality (A.K. Jacox, et al. (1994) and EM. Ferrante, et al. (1996)). For this reason, in 1980 the World Health Organization began an effort to codify prevailing approaches to cancer pain relief and to encourage implementation of these methods as health policy throughout the world. This review will summarize subsequent progress in assessing cancer pain and treating it by means of systemic and intraspinal pharmacologic management as well as nonpharmacologic interventions. Important elements of the initial pain evaluation include a detailed history, physical examination, psychosocial assessment and, when appropriate, a diagnostic plan to detect the cause of new or escalating pain. Moreover, clinicians treating cancer patients should recognize common cancer pain syndromes. Systemic pharmacologic management, the cornerstone of cancer pain management, must be individualized. The three major classes of drugs used today in the treatment of cancer pain, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvants will be discussed. The WHO three-step ladder to guide cancer pain treatment will be reviewed. The discussion will then rum to neuroaxial pharmacologic management in the treatment of refractory pain resistant to systemic drugs. Factors to consider in deciding whether to begin spinal opioid therapy will be described. Finally, nonpharmacologic management of cancer pain will be surveyed, ranging from physical and psychosocial modalities to more invasive therapies.