CANCER PAIN MANAGEMENT

Pain occurs in more than 80% of cancer patients before death. Because of the increase in the frequency of cancer deaths worldwide, it is imp erative to address cancer pain as a public health problem. Until recen tly, educational efforts were focused on treatment issues rather than adequate assessment. The approach to pain intensity as a multidimensio nal construct has helped in focusing treatments and identifying progno stic factors. Valid tools have been developed that allow multidiscipli nary assessment of these prognostic factors and their complex interrel ationship with the analgesic response. As a result of increased opioid exposure, patients are currently developing newer toxicities, mostly central excitability including delirium, myoclonus, grand mal seizures , and hyperalgesia. The observation that more than 80% of patients wil l require alternate routes for opioid delivery before death led to the development of a number of novel and effective alternate routes for d elivery. Finally, in recent years it has become evident that some spec ific pain syndromes need to be addressed using specific assessment and management techniques. Incidental pain, somatization, neuropathic pai n, and cancer pain in patients with alcoholism and drug addiction are some of these syndromes. (C) Acta Anaesthesiologica Scandinavica 41 (1 997).