Cancer Pain–Health Professional Version (PDQ®)

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Changes to This Summary (03/10/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Cancer Pain

Revised text to state that determining whether the pain requires pharmacologic and/or other modalities of treatment is one step in effective pain management.

Revised text to include patient prognosis, predictive factors for pain control (e.g., psychological distress), and impact on function as issues to be considered when determining the most appropriate treatment.

Added text to state that patients and family caregivers should be educated about the safe storage, use, and disposal of opioids; and that one study demonstrated that improper use, storage, and disposal are common among cancer outpatients (cited Reddy et al. as reference 2).

Added text to state that an open-label randomized trial of low-dose morphine versus weak opioids to treat moderate cancer pain suggests that it is acceptable to bypass weak opioids and go directly to strong opioids (step 3 agents) for patients with moderate cancer pain, as patients randomly assigned to the low-dose morphine arm had more frequent and greater reduction in pain intensity with similarly good tolerability and earlier effect (cited Bandieri et al. as reference 6).

Pain Classification

Added text about how emotional distress may also contribute to the pain experience.

Added Portenoy et al. and Narayana et al. as references 10 and 11, respectively.

Pain Assessment

Revised text to state that psychosocial and existential factors that can affect pain are also assessed and appropriately treated.

Pharmacologic Therapies for Pain Control

Revised Table 2 to note that for fentanyl, cachectic patients have decreased absorption from the transdermal patch (cited Heiskanen et al. as reference 20).

Revised Table 3 to note that intramuscular injection of opioids, acetaminophen, and ketorolac is typically avoided because of pain from the injection. Also added fentanyl as a subcutaneous agent (cited Oosten et al. as reference 24).

Added text to state that rapid titration of methadone may result in delayed respiratory depression because of its long half-life (cited Modesto-Lowe et al. as reference 32).

Revised text to state that careful titration of naloxone should be considered because it may compromise pain control, and may precipitate withdrawal in opioid-dependent individuals. Also added text to state that because of methadone’s long half-life, naloxone infusion may be required for respiratory depression caused by methadone.

Modalities for Pain Control: Other Approaches

Revised text to state that intrathecal pumps may make it difficult for patients to access hospice care because of care needs and cost issues.

Revised text to state that cordotomy is generally reserved for patients considered to be in the last 2 years of life, with pain refractory to other approaches, and may be done via the open route or the percutaneous route.

Added text to include social workers as part of palliative care interdisciplinary teams. Also added text to state that many palliative care teams now call themselves supportive care teams because this term is more acceptable to many referring providers and to some patients and families (cited Fadul et al. and Dalal et al. as references 12 and 13, respectively).

Added text to state that single-fraction radiation has several potential advantages: greater convenience, lower cost, and less breakthrough pain associated with transportation to the radiation facility and with getting on and off the radiation table.

General Approaches to Pain Treatment

Revised text to state that orthopedic consultation is frequently necessary to determine whether operative intervention is required to prevent and/or treat pathological fractures.

This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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