The assessment and management of cancer pain is a complex enterprise. This chapter will describe key elements of assessment and management, critique the emerging supportive evidence base, and discuss the basis for future studies of the underlying science.
Assessing cancer pain
Aspects of clinical practice
The goals of cancer pain assessment include characterization of the pain complaint and integration of information in a manner that leads to inferences about underlying pathophysiology and syndrome recognition. Th is understanding is the foundation for diverse management strategies that often rely on multiple modalities to relieve pain while minimizing side eff ects and treatment burden.
Pain may be evaluated in terms of severity, location, quality, and other aspects. Among the most salient elements is measurement of pain intensity, which may be viewed as the cutting edge of the longstanding effort to develop a scientific foundation to assessment.
The scientifi c basis of patient ratings of pain intensity began more than half a century ago with the early development of clinical trials methodology for the evaluation of analgesics. These studies confirmed that a subjective experience like pain can be validly measured using self-reported rating scales. In the clinical setting, however, the measurement of cancer pain intensity often is beset by practical problems. Some patients are not able to respond with numerical descriptors. Other patients may have an impaired cognitive status or are simply unable to answer questions. This is an area where much work still needs to be done.
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