The principles of pain management in advanced cancer

Pain is the most feared symptom for patients with advanced cancer. Although effective pain relief is critical to preserving quality of life for these patients, the incidence of uncontrolled pain is high. A variety of physiological mechanisms contribute to cancer pain, and psychological, social and spiritual factors all contribute to the overall pain experience. Therefore the rationale for treatment must be appropriate. Regular assessment of both pain and treatment is indicated, as is the management of adverse reactions of treatment. In most cases, pain may be managed by conventional means (e.g. oral analgesia) but sometimes other modes of administration (e.g. transdermal/subcutaneous routes) may be more appropriate. In addition, some patients will require interventional treatment such as nerve blocks or radiotherapy, while in other patients non-drug therapies may be more appropriate. Improved assessment, education and communication can do much to alleviate pain in the patient with advanced cancer.