Management of Cancer Pain in Primary, Secondary, and Palliative Care

Abstract

Section 26.1: Pain is the most frequent complication of cancer. Treatment needs to be holistic, involving carers and/or family. It needs to include physical, emotional, psychological, and spiritual aspects and should be reviewed regularly. Good records need to be kept in order to facilitate cooperation with medical colleagues. Pharmacological titration should follow the WHO pain ladder. Opioids and opiates should be administered in the most appropriate form. Physiotherapy and alternative forms of medicine may play an important role in the management of cancer pain. In Sect. 26.2, the approach to assessment and management of cancer pain is discussed, with a focus on care delivered in hospital and in specialist palliative care settings. Opioids are central to cancer pain management and should be individualised to the patient based on the pain history and side effects of the drugs. Opioid switching may be considered in selected patients who do not respond to morphine first line. The impact of renal and hepatic impairment should be considered in the safe prescribing of opioids. A range of adjuvant treatments including drugs for neuropathic pain may complement opioid analgesia in cancer pain.