Cancer is diagnosed in over one million Americans annually, and one of five deaths in the United States about 1,400 per day result from cancer. Despite recent advances in the understanding of pain and pain management approaches, pain control remains a significant problem for patients with cancer. This guideline is designed to help any clinician who works with any oncology patient in any setting to understand the assessment and treatment of pain and associated symptoms.

The guideline was developed by an interdisciplinary panel of clinicians, patients, and experts in health policy. The panel used a combination of scientific evidence and expert judgment to make recommendations about pain management in patients with cancer.

The guideline makes recommendations about the assessment and management of pain. Interventions described include the use of (1) analgesics and adjuvant drugs; (2) cognitive/behavior strategies; (3) physical modalities; (4) palliative radiation and antineoplastic therapies; (5) nerve blocks; and (6) palliative and ablative surgery.

The cost of cancer pain in suffering, disability, and quality of life is high. The guidelines recommend that cancer pain be treated aggressively by pharmacologic and nonpharmacologic approaches. In most instances, pain can be treated effectively with relatively low-cost, noninvasive therapies. Given this evidence, health system barriers that interfere with effective pain management -- such as restrictive legislation regarding the uses of opioid analgesics and third-party payer practices that do not reimburse for less invasive interventions -- should be changed.

Contents

• [Inside Front Cover]
• Guideline Development and Use
• Foreword
• Dedication
• Panel Members
• Acknowledgments
• Executive Summary
• Explanation of Strength of Evidence
• 1. Overview
  • Recommendations
  • Scope of the Problem
  • Importance of Controlling Cancer Pain
  • Suffering, Loss of Control, and Quality of Life
  • Overview of Pain and Pain Management Modalities
  • Barriers To Effective Pain Management
  • Methods Used To Develop the Guideline
  • Organization of Guideline
• 2. Assessment of Pain in the Patient With Cancer
  • Recommendations
  • Initial Pain Assessment
  • Ongoing Pain Assessment
  • Assessment of Common Cancer Pain Syndromes
  • Assessment of New Pain
• 3. Pharmacologic Management
  • Recommendations
  • The WHO Ladder
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  • Opioids
  • Adjuvant Drugs
  • Antineoplastic Therapies
  • Influence of Concurrent Medical Conditions on Pharmacotherapy
  • Pharmacologic Treatments Not Recommended
  • Discharge Planning Regarding Medications
• 4. Nonpharmacological Management: Physical and Psychological Modalities
  • Recommendations
  • Introduction
  • Physical Modalities
  • Psychosocial Interventions
• 5. Nonpharmacologic Interventions: Invasive Therapies
  • Recommendations
  • Introduction
  • Radiation Therapy
  • Anesthetic Techniques
  • Neurosurgery
  • Surgery
• 6. Procedure-Related Pain in Adults and Children
  • Recommendations
  • Managing Procedure-Related Pain
  • Pharmacologic Strategies for Procedural Pain
  • Sedation for Procedural Pain
  • Additional Pain Management Strategies for Lumbar Puncture and Bone Marrow Aspiration
• 7. Pain in Special Populations
  • Recommendations
  • Pain in Neonates, Children, and Adolescents
  • Elderly Patients
  • Patients With Psychiatric Problems Associated With Cancer Pain
  • Substance Abusers
  • Minority Populations
  • Pain in Patients With AIDS
• 8. Monitoring the Quality of Pain Management
  • Recommendations
• Acronyms
• Glossary
• Contributors
• Attachments
• References

Suggested citation:

Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No. 9. AHCPR Publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994.