Managing cancer pain: basic principles and invasive treatments

Severe pain associated with cancer continues to be a substantial problem for patients, physicians, and the health-care system. During the past 2 decades, major advances have occurred in the understanding of the pathogenesis of pain. Likewise, considerable advances have occurred in the conceptualization of and clinical approach to cancer pain. This article briefly summarizes the basic principles of the treatment of cancer pain and in particular describes the World Health Organization 3-step "analgesic ladder" for the treatment of cancer pain. In addition, several invasive approaches for managing various refractory cancer pain syndromes are discussed.