Pharmacologic management of cancer pain

More than three quarters of cancer patients experience chronic pain during the course of their disease. With optimal pharmacotherapy alone, 70% to 90% could achieve adequate relief. Optimal pharmacotherapy begins with a comprehensive pain assessment, which defines the nature of the pain complaint and clarifies the degree to which pain and other factors contribute to impaired quality of life. Although the potential analgesic consequences of primary therapy are always considered, only radiotherapy is used commonly. Patients with persistent moderate to severe pain should be treated with an appropriate opioid regimen, which is based on careful selection of an opioid drug and route of administration, individualization of the dose through titration based on repeated assessment of the patient, and ongoing efforts to manage side effects. The use of adjuvant analgesics and the use of sequential opioid trials may improve the outcome of therapy for patients who fail to promptly attain a favorable balance between analgesia and side effects during an opioid trial.