Implementation of an anesthesia pain management service program

Pain management has emerged as a priority patient care issue, especially in the oncology setting. For most patients with advanced cancer, pain is a major symptom. Cancer pain can be acute, chronic, or a combination. Patient-controlled analgesia (PCA) and epidural analgesia have been shown to be safe and effective techniques for the management of pain in the acute and chronic pain populations. Little information is available concerning the use of these modalities in patients with cancer. The authors describe the experience of instituting a pain management program at Memorial Sloan-Kettering Cancer Center. The objectives of the program, the components necessary to institute the pain management program, and the roles of PCA and epidural analgesia are noted. Recommendations are offered for organization of services, reliance on primary nurses, and involvement of the multidisciplinary team. Safety concerns and other patient-related issues are highlighted. Based on Memorial Hospital experience, the authors conclude that an acute pain service has an important role in meeting the needs of patients with cancer.