Pharmacological management of cancer pain

Given modern techniques of pain assessment and management, it is now possible to be optimistic about cancer pain control. Assessment of cancer pain must include information about the site(s) of pain, pathophysiology, pain severity, and quantification of analgesic responses. Correct diagnosis of common pain patterns including breakthrough and incident pain are essential. The principles of analgesic use are well defined. The concept of rescue dosing in safe analgesic titration and management of breakthrough/incident pain is a key concept. Individualization of opioid dosing is important and this is facilitated by a number of dosing strategies. Choice of specific opioid is often less important than correct dosing, as side effects are similar among the commonly prescribed drugs. Anticipations and management of common side effects improve the therapeutic index. Alternate routes of administration are important, usually because of loss of the oral route of administration. Misunderstandings about opioids are common and patient and family education paramount. Adjuvant analgesics are necessary for good pain control, but have important differences in indications, usage, and side effects compared with opioids. First-rate pain management is a basic professional and humanitarian responsibility of the skilled clinical oncologist.