Volume 105, Issue s5

Management of cancer pain is still a significant problem in healthcare today despite the fact that cancer pain can be controlled in approximately 90% of patients. Emotional, psychosocial, and spiritual suffering associated with the disease complicates the problem. Guidelines issued by the Agency for Healthcare Research and Quality address management of cancer pain. Pain intensity scales, complementary and alternative methods, and the role of the interdisciplinary care team, as well as the need to provide spiritual support to the patient and family, are included in the discussion.

Many developments have occurred in the prevention and treatment of cancer, but death from this disease is still common. According to the World Health Organization, 7 million deaths were due to cancer worldwide in 1999. For dying patients, it is most important to improve quality of life and relieve suffering. Palliative care is defined as the active total care of patients whose disease is not responsive to curative treatment. It encompasses all treatment modalities that are aimed at enhancing quality of life rather than curing disease. Each patient's definition of quality of life is unique. As such, it is important to treat each person as an individual and to continue to view the patient holistically. Controlling cancer-related symptoms can ameliorate the patient's limited remaining time with family and friends. Palliative chemotherapy, rehabilitation, radiation therapy, surgery, and interventional pain management can help to achieve this objective.

Nonpharmacologic interventions are important adjuncts to treatment modalities for patients with cancer pain. A variety of modalities can be used to reduce pain and concomitant mood disturbance and increase quality of life. Physicians may feel relatively uninformed about which modalities have been used for patients with cancer and which have scientific support. This article reviews a few of the nonpharmacologic and complementary and alternative modalities commonly used by patients with cancer pain. It focuses on those modalities that have empirical support or promising preliminary evidence, with the goal of familiarizing physicians with treatment modalities that may complement regular oncologic care.

Cancer remains the second most common cause of death in the United States despite advances in prevention, early detection, and newer treatment protocols. Pain continues to be the most feared complication of this diagnosis. Numerous studies have shown that when the World Health Organization treatment guidelines are followed, 90% of patients are pain-free. Although evidence is convincing that opioids are effective in the treatment of patients with cancer pain, reluctance to use them continues. Barriers to opioid use are multifactorial, but with education of healthcare providers and patients, treatment to manage pain will be more effective.