Cancer pain control


Session type:

Eduardo Bruera
The University of Texas MD Anderson Cancer Center, USA


Pain occurs in approximately 80% of patients with advanced cancer and it is the most concerning symptom to patients and their families. In cancer patients pain is mostly due to nociceptive input by the primary tumour or metastatic locations. However, in approximately 30% of patients there are other non-tumour related mechanisms involved such as treatment related pain syndromes or unrelated conditions. Some of the most important progress in the management of cancer pain has been improved assessment of the multiple dimensions that contribute to the patient's pain expression as well as the multiple and complex symptoms that accompany pain in patients with cancer. A patient's expression of increased pain intensity should not be equated with increased nociceptive input but rather always interpreted as a multidimensional construct. Improved understanding of the complexity of pain expression has led to much better management including multimodal techniques including opioid analgesics, adjuvant drugs, excellent management of side effects, counselling, rehabilitation, and occasionally anaesthesiological procedures. In all cases appropriate antineoplastic management should be considered.

Recent data suggests that even with impeccable assessment and specialist driven management, a considerable proportion of patients have persistent moderate to severe pain and these patients with refractory pain syndromes require interdisciplinary assessment and management. Research opportunities in cancer pain assessment and management will be presented.