Pain relief in active patients with cancer: analgesic drugs are the foundation of management.

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Pain relief in active patients with cancer: analgesic drugs are the foundation of management Mary BainesThe greatest fear of patients with cancer and of their families is unrelieved pain.Sadly, this fear has often been justified for in the past cancer pain has been poorly understood and inadequately treated.Fortunately, the situation is now improving and most patients with cancer in the developed world should be assured of good relief of pain with the appropriate use of analgesics, adjuvant drugs, radiotherapy, and nerve blocks. Prevalence of painThe prevalence of pain has been well studied, varying from 30% to 45% in patients when cancer is diagnosed' and being up to 50% in children and adults receiving anticancer treatment,2 and 70% in those with advanced disease.The World Health Organisation estimates that every day 3 5 million people are suffering from cancer pain.4Nature of cancer painPain has been described as a somatopsychic experience,' with its intensity depending both on the extent of tissue damage and on the patient's psychological state.In patients with cancer the pain will be exacerbated by associated physical symptoms such as anorexia or vomiting and by the inevitable fear of deterioration, separation, and death.Pain is not only caused by an expanding tumour but may be due to the treatment, debility, or concurrent disease.In one study a third of the pains in patients with advanced cancer were non-malignant in origin and 80% of patients had more than one anatomically distinct pain.