Pain affects more than 70% of cancer patients but is often undertreated.
Methods
The authors review and present methodologies to maximize proper palliative approaches to this symptom for the majority of patients.
Results
The World Health Organization's stepwise guide to pain control serves as an excellent basis for management. Around-the-clock dosing, using adjuvant treatments, and using noninvasive routes of administration provide good pain control for 80% of patients.
Conclusions
Barriers to effective pain control will be reduced as new JCAHO standards regarding pain control are implemented.
References
1.
National Hospice and Palliative Care Organization.Facts and Figures on Hospice Care in America. Available at: http://www.nhpco.org. Accessed on January 18, 2001.
2.
Death and Dying in America: Too Much Technology, Too Lit- tle Care.Princeton, NJ: Robert Wood Johnson Foundation; May 1998.
3.
BresciaF.J., PortenoyR.K., RyanM.. Pain, opioid use, and survival in hospitalized patients with advanced cancer.J Clin Oncol.1992; 10: 149–155.
4.
CleelandC.S., GoninR., HatfieldA.K.. Pain and its treatment in outpatients with metastatic cancer.N Engl J Med.1994; 330: 592–596.
5.
AllA., HuyckeL.I.. Pain, cancer and older adults.Geriatr Nurs.1999; 20: 241–248.
6.
DautR.L., CleelandC.S., FlaneryR.G.. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases.Pain.1983; 17: 197–210.
7.
OwensM.R., McConveyG.G., WeeksD.. A pilot program to evaluate pain assessment skills of hospice nurses.Am J Hosp Palliat Care.2000; 17: 44–48.
8.
ShannonM.M., RyanM.A., D'AgostinoN.. Assessment of pain in advanced cancer patients.J Pain Symptom Manage.1995; 10: 274–278.
ChangH.M.. Cancer pain management.Med Clin North Am.1999; 83: 711–736.
11.
World Health Organization.Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee.Geneva, Switzerland: WHO;1990. Technical report series, 0512-3054;804.
12.
World Health Organization.Cancer Pain Relief: With a Guide to Opioid Availability.2nd ed.Geneva, Switzerland: WHO;1996.
13.
GrossmanS.R., BenedettiC., BrockC.. NCCN practice guidelines for cancer pain.Oncology.2000; 14(11A): 135–150.
14.
JacoxA.K., CarrD.B., PayneR.. Management of Cancer Pain: Clinical Practice Guideline.Rockville, Md: Agency for Healthcare Policy and Research; 1994. US Dept of Health and Human Services publication No. 94-0592.
15.
BrueraE., NeumannC.M.. Role of methadone in the management of pain in cancer patients.Oncology.1999; 13: 1275–1282.
16.
PortennoyR.K., LesageP.. Management of cancer pain.Lancet.1999; 353: 1695–1700.
17.
GourlayG.K., KowalskiS.R., PlummerJ.L.. The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects.Pain.1989; 37: 193–202.
FoleyK.. Controlling cancer pain.Hosp Pract.2000; 35: 101–112.
20.
ViganoA., BrueraE., Suarez-AlmazorM.E.. Age, pain intensity and opioid dose in patients with advanced cancer.Cancer.1998; 83: 1244–1250.
21.
PorterJ., JickH.. Addiction rare in patients being treated with narcotics.N Engl J Med.1980; 302: 123.
22.
JenkinsC.A., BrueraE.. Nonsteroidal anti-inflammatory drugs as adjuvant analgesics in cancer patients.Palliat Med.1999; 13: 183–196.
23.
MaxM.B., LynchS.A., MuirJ.. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy.N Engl J Med.1992; 326: 1250–1256.
24.
TwycrossR.G.. Symptom Management.2nd ed.Oxford: Radcliff Medical Press;1997.
25.
NolanL., O'MalleyK.. Adverse effects of antidepressants in the elderly.Drugs Aging.1992; 2: 450–458.
26.
BrueraE., MillerM.J.. A randomized double blind, crossover trial of intravenous lidocaine in treatment of neuropathic cancer pain.J Pain Symptom Manage.1992; 7: 138–140.
27.
CrosbyV., WilcockA., CorcoranR.. The safety and efficacy of a single dose (500 mg or 1 g) of intravenous magnesium sulfate in neuropathic pain poorly responsive to strong opioid analgesics in patients with cancer.J Pain Symptom Manage.2000; 19: 35–39.
28.
GrondS., ZechD., DiefenbachC.. Assessment of cancer pain: a prospective evaluation in 2,266 cancer patients referred to a pain service.Pain.1996; 64: 107–114.
29.
FoleyK.M.. The treatment of cancer pain.N Engl J Med.1985; 313: 84–95.
