THE MANAGEMENT OF CANCER PAIN

Surveys indicate that clinicians are frequently ill equipped to treat cancer pain. Pain is often poorly assessed, and many caregivers lack s ufficient knowledge to optimize treatment. Effective management requir es an understanding of pain pathophysiology, the ability to identify a nd evaluate pain syndromes, and familiarity with proven therapeutic st rategies. Opioid pharmacotherapy is the mainstay of treatment. Practic al aspects of opioid therapy include selection of both drug and route, dose titration, and management of side effects. Specific strategies f or the management of patients who are unable to attain an acceptable b alance between pain relief and side effects include both noninvasive i nterventions (such as adjuvant analgesics, psychological therapies, an d physiatric techniques) and invasive interventions (such as the use o f intraspinal opioids, neural blockade, and neuroablative therapies). Sedation is an option at the end of life for the treatment of pain tha t is refractory to other interventions. These approaches can provide a dequate relief to the vast majority of patients, most of whom will res pond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative med icine.