Medical treatment of chronic cancer pain

Careful assessment is a necessary preliminary to treatment; pain may be caused by a variety of mechanisms or associated with a non-malignant condition. In the majority of patients treatment should be planned on a multimodality basis. The fact that pain is a somato-psychic phenomenon must not be forgotten. Analgesics should be gives regularly, usually every four hours. Whereas the optimal dose of non-narcotic and weak narcotic drugs vary little the optimal dose for the stronger narcotic analgesics varies considerably. Aspirin or other non-steroidal anti-inflammatory drugs should always be used in metastatic bone pain, usually with a narcotic. Morphine sulphate in solution administered by mouth is the narcotic analgesic of choice in far-advanced cancer. When used as described, escalation of dose (tolerance) is not a practical problem. Physical dependence does not prevent the downward adjustment of dose should this become feasible as a result of non-drug intervention. Psychological dependence (addiction) does not occur if the patient is closely supervised and given adequate emotional support.