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Management of Cancer Pain

Cancer pain has long been, and continues to be, one of the most important and pressing issues in modern society. This importance stems from the following considerations: (a) cancer pain afflicts millions of people throughout the world annually. In addition to the severe physiologic, emotional, affective, and economic impact of pain in general, cancer pain has special attributes and significance to the patients and their families; (b) although when properly used the drugs and other therapeutic modalities currently available are effective in relieving the pain in most cancer patients, they are often inadequately applied. Consequently, many patients spend their last weeks and months of life in great discomfort, suffering and disability, which preclude “a quality of‘ life” that is vital to them and their families. ‘The object of this paper is to give a brief overview of: (a) the prevalance and magnitude ofcancer pain; (b) the physiologic, psychologic affective and sociologic effects of cancer pain; (c) the current status of its management and the reasons for deficiencies which exist in cancer pain therapy; (d) the etiology and possible mechanisms of cancer pain; and (e) a summary ofthe basic principles of management. This material is intended to provide the background for subsequent papers. Following long tradition, I will use the term “cancer pain” generically to include pain caused by any malignant neoplasm or as a consequence of therapeutic intervention for the disease, or both.