Cancer pain management

Pain is one of the most common and distressing symptoms among cancer patients, with increasing frequency and severity as disease progresses. Despite significant progress in research and education on pain management, there remain multiple barriers to effective pain control. Patients with cancer may experience pain from progressive disease, diagnostic procedures, cancer treatments and/or other comorbidities. In addition to a focused pain history and physical examination, it is critical to assess common factors that may affect pain management. Patients with moderate to severe cancer pain can be started on conservative doses of short-acting opioids around the clock if appropriate with their pain picture, with as needed opioid (usually 10% –15% of total daily dose) every 2–4 hours for breakthrough pain. In light of the opioid epidemic, the role of the physician becomes two-fold: To advocate for and provide adequate access to opioids while at the same time, to increase vigilance and enhance safe prescribing of opioids.