A major fear of cancer patients is the fear of uncontrolled pain. As disease progresses so does the prevalence of pain, with up to 90% of those with advanced disease suffering from severe pain, and as many as 25% of those dying with their pain unrelieved. Despite these disheartening statistics, currently available pharmacologic therapies can mitigate up to 90% of cancer pain. Why the apparent disconnect?

If the capstone goal of an effective pain management regimen is decreased pain and concomitant symptoms, and hence improved quality of life, the underlying cornerstone must be disciplined, thorough, and ongoing assessment. However, 76% of physicians admit that their own inadequate assessment is the predominant barrier to adequate cancer pain management. We must develop systematic approaches to pain assessment in the context of overall symptom burden, coupled with knowledge of common pain syndromes affecting cancer patients, expertise in the pharmacology of available opioids and adjuvants, and education and reassurance of patients and their families. We then can prescribe rational pain management plans that can enhance the quality of life for as long as there is life.

In addition to acquiring information for diagnosis and treatment, clinical assessment offers the opportunity to develop a relationship with the patient that sets the stage for improved therapeutic success. A sound initial assessment will provide the benchmark for measuring that success. Pain staging may also be prognostic for clinical course.