Introduction

Roughly 80-90% of pain due to cancer can be relieved relatively simply with oral analgesics and adjuvant drugs in accordance with World Health Organisation (WHO) guidelines. WHO guidelines should be used in combination with interdisciplinary management. Relief of pain at the expense of side-effects is unacceptable to most patients; therefore a variety of treatment modalities is required.

Failure to control pain can result in many other problems e.g. fatigue, anorexia, depression, anxiety, constipation, nausea, and hopelessness. It is more difficult for the patient with pain to continue with demanding cytotoxic treatment and hospital visits. Pain control is an obvious priority for patients with cancer, whether embarking on curative or palliative treatment.

The commonest causes of uncontrolled cancer pain are:

♦ Lack of sophistication in patient assessment, resulting in mis-diagnosis of cause and type of pain and failure to detect general distress, which lowers the pain threshold.

♦ Lack of a systematic approach to analgesia. 'Panic prescribing' is more likely to result in unacceptable side-effects.

♦ Lack of knowledge of opioid pharmacology and of evidence for adjuvant analgesics and non-steroidal anti-inflammatory drugs.

♦ Lack of sophistication in use of opioids and adjuvant analgesics, in particular, failure to prevent or treat drug side-effects.

An accurate patient assessment underpins appropriate analgesic choice. If pain distress is greater than pain severity and this is not identified it means:

♦ The patient is especially susceptible to opioid toxicity (pain is the physiological antagonist to the side-effects of opioids).

♦ The 'pain' will never be adequately dealt with if pyschological distress is treated as a physical pain.

♦ Appropriate strength of analgesic cannot be chosen.

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