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Pain is common in cancer patients, although its prevalence varies with the primary
site and stage of the malignancy. High rates of pain are observed with prostate, bone,
and gynaecological primary cancers, while it is usually less problematic in haematological
malignancies. Unfortunately, many patients and healthcare professionals still believe
that the late stages of cancer are inevitably painful, which leads to therapeutic
nihilism. Clinicians should recognize that ‘cancer pain’ may arise not only from the
malignancy, but also from its treatment and the presence of concomitant conditions.
Current research focuses on the mechanisms, treatment, and consequences of pain. Recent
advances have been made with novel agents, such as N-methyl-d-aspartate (NMDA) receptor antagonists, and new formulations, such as transdermal
drug delivery systems. Non-analgesic approaches to pain control, such as the use of
bisphosphonates or intravenous radionuclides for bone metastases, and the roles of
nerve blocks and orthopaedic surgery, soon will be evaluated. Quality-of-life and
satisfaction studies are needed to evaluate the impact of pain on patient functioning
and its effects on family, social, and economic life. The World Health Organization
has proposed a three-tier approach to cancer pain management, in which drugs ranging
from non-steroidal anti-inflammatory drugs (NSAIDs) to strong opiates are titrated
to the level of pain. Oncologists have an important role in implementing this approach
and in seeking more rational legislation concerning the prescribing of opioids for
the treatment of cancer pain.
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© 1997 Published by Elsevier Inc.
