sess it.
Acute pain is usually associated with accepted expressions of
pain ( increased heart rate and blood pressure, moaning,
sleeplessness, inability to work, absence of laughter)
Chronic pain may have no observable characteristics, the
patient may "appear" comfortable and it is important for the
caregiver and health care provider to believe the patient's
complaints of pain.
The most commonly used pain assessment scale is a scale of 0 to
10, with 0 being no pain at all and 10 being the worst pain
Pain assessment should include location and duration of pain,
characteristics (throbbing, sharp, steady, dull, aching, stabbing),
relieving and aggravating factors.
Assess current pain medication regimens including effectiveness
and tolerance of side effects.
Drug therapy is the cornerstone of cancer pain management. It
must be individualized to each patient.
The World Health Organization has developed a three step
hierarchy which is proven to be effective in relieving pain in about
90% of cancer patients:
use the simplest dosage schedules and least invasive pain
management modalities first
for mild to moderate pain use aspirin (unless
contraindicated), acetaminophen, or non- steroidal
anti-inflammatory drugs (Step 1)
when pain persists or increases, add an opioid (Step 2)
if pain continues or becomes moderate to severe, increase the
opioid potency or dose (Step 3)
schedule doses on a regular schedule to maintain the level of
drug that will help prevent recurrence of pain
administer medications for long-term cancer pain on an
around-the-clock basis (usually sustained release preparations)
with additional doses for breakthrough pain as needed.
All patients on narcotics should be on a bowel regimen to
prevent constipation (see Constipation module for sample bowel
When patients cannot tolerate oral routes of medication,
consider rectal administration, IV infusion, subcutaneous infusion,
patient controlled analgesia by pump or intraspinal narcotic
Non-pharmacologic interventions may include relaxation
techniques, distraction, hypnosis, topical stimulation of skin
(heat/cooling, massage, vibration, menthol, accupuncture).