Cancer pain

Should be able to provide pain relief for 70-90% of patients.

Cancer pain affects 49-57% of patients with curable cancer and 56-75% of patients with advanced disease.

Prevalence of pain highest in patients with head and neck cancer (70%), gynecologic cancer (60%), gastrointestinal cancer (59%), lung cancer (55%), breast cancer (54%), and urological malignancies (52%).

Variation in the prevalence of cancer pain has less to do with the primary origin of the cancer and more related to the treatment associated with the individual cancer types, and the expression of disease in individual patients.

Most cancer related pain classified as nociceptive, neuropathic or mixed.

Frequently presents as a locoregional syndrome.

15% of patients with cancer pain have anatomically localized pain such as pain originating from bone metastases or neuropathic pain from nerve compression or invasion.

Intervals of poorly controlled she is cancer pain can lead to progressive neuronal remodeling and altered sensitization.

Poorly controlled pain impairs overall function, mood, appetite, sleep patterns and quality of life.

Persistent pain in patients with cancer may be related to the underlying tumor, from manifestations of metastases, and/or from radiation, chemotherapy or surgery.

Often cancer pain cannot be adequately controlled by systemic analgesic treatments because the high doses required for analgesia trigger adverse affects.

Persistent cancer-related pain is categorized as somatic, visceral, and/or neuropathic in origin.

Nociceptive pain refers to pain activated by nociceptive neurons with fibers that are sensitive to noxious stimuli and can be separated into somatic and visceral components.

Bone pain is the most common type of nociceptive cancer pain.

Neuropathic pain caused by injury to the peripheral or CNS and can be caused by the tumor itself, by therapy such as neurotoxic chemotherapy or by an unrelated process such as postherpetic neuralgia.

Management of pain requires appropriate assessment, including documentation of pain characteristics, understanding the mechanisms of pain, identifying modulating factors, and reassessments over time.

Short term outcomes for patients with localized pain syndromes are frequently achieved by regional administration of local anesthetics or buy selective neurolysis, neither approach however is durable.

Cancer pain remains inadequately controlled in 50% of patients.

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