Cancer pain: A ten year perspective

The year 1996 marked the tenth anniversary of the publication of the World Health Organization (WHO) monograph Cancer Pain Relief, and the tenth anniversary of the formation of the first state cancer pain initiative in the United States. In 1996, the third edition of the WHO monograph was published and there were cancer pain initiatives formed or in formation in all of the states. These and other important activities which improved understanding and management of cancer pain between 1986 and 1996 are reviewed. The WHO cancer control program, the cancer pain initiative movement, published studies which characterize cancer pain incidence and management, development of instruments to allow patients to better report their pain intensity, and health care provider attitudes about cancer pain management are described. Improved understanding of the differences between dependence on and addiction to opioids is characterized. Regulatory agency influence on pain control is discussed. Efforts to make necessary innovations are addressed and some important, but as yet unanswered, questions are proposed. Forces that have changed the landscape of cancer pain control are discussed, as are several continuing barriers to improved outcomes for patients in pain.