The management of cancer pain

Any therapeutic strategy developed for patients experiencing cancer pain de pends on the goals of care, which can be broadly categorized as prolonging survival, optimizing comfort, and optimizing function. The relative priorit y of these goals for any individual should direct therapeutic decision-maki ng. By combining primary treatments, systemic analgesic agents, and other techn iques, most cancer patients can achieve satisfactory relief of pain. In cas es where pain appears refractory to these interventions, invasive anestheti c or neurosurgical maneuvers may be necessary, and sedation may be offered to those with unrelieved pain at the end of life. The principles of analgesic therapy are presented, as well as the practical issues involved in drug administration, ranging from calculating dosage to adverse effects, and, when necessary, how to switch and/or combine therapi es. Adjuvant analgesics, which are drugs indicated for purposes other than relief of pain but which may have analgesic effects, are also listed and di scussed in some detail. Surgical and neurodestructive techniques, such as rhizotomy or cordotomy, a lthough not frequently required or performed, represent yet other options f or patients with unremitting pain and diminished hope of relief. Although cancer pain can be a complex medical problem arising from multiple sources, patients should be assured that suffering is not inevitable and t hat relief is attainable.