Pain is defined as an unpleasant sensory and emotional experience with actual or potential tissue damage. It is highly subjective and therefore open to modification. The idea of total pain (Figure 24.1) should be used when considering its management.
Pain is one of the most feared symptoms of malignant disease, with at least two-thirds of cancer patients suffering significant pain throughout the course of their disease. Patients with cancer can have multiple sites of pain and multiple types of pain, and each requires careful assessment and treatment (Table 24.1).
Pain assessment
Cancer does not always cause pain, but if it does, assessment may be difficult due to complex or multiple sites of involvement. Ensure there is thorough assessment and documentation for each pain, remembering that some pains may change with time, therefore requiring reassessment. It is important to determine the patient’s ideas, concerns and expectations, ensuring they have realistic expectations of treatment. Explore their social, psychological and spiritual issues regarding their pain and remember that these are significant to how they will perceive and manage their discomfort. Physical examination may help establish a cause, and imaging may be required.
Pain is multifactorial, either directly related to the malignancy or indirectly due to systemic complication (e.g. due to cachexia or pressure sores), or due to pre-existing co-morbidities.
Somatic pain is transmitted via the spinothalamic tract. This decussates at the level of the spinal cord, transmitting to the cortex via the thalamus, giving intensity and topographical location of the stimuli. It is commonly described as crushing, tearing and throbbing, and is usually well localised.
Neuropathic pain
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