Chronic Nociceptive Pain Syndromes: Cancer Pain

  • Russell K. Portenoy


There is abundant evidence that cancer pain is undertreated despite the availability of therapies that could benefit most patients.1 Undertreatment has many causes, among the most important of which is inadequate assessment.2,3 Assessment is a dynamic process that includes evaluation of presenting problems, elucidation of pain syndromes and pathophysiology, and formulation of a comprehensive plan for continuing care.4–8 In this process, the management of pain must be incorporated within a broader therapeutic agenda that addresses the need for antineoplastic treatment, symptom palliation, and functional rehabilitation. 8,9


Neuropathic Pain Pain Syndrome Cancer Pain Epidural Space Odontoid Fracture 
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  1. 1.
    Stjemsward J, Teoh N. The scope of the cancer pain problem. In: Foley KM, Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy. Second International Congress on Cancer Pain. New York: Raven Press; 1990;16:7–12.Google Scholar
  2. 2.
    Grossman SA, Sheidler VR, Swedeen K, et al. Correlation of patient and caregiver ratings of cancer pain. J Pain Symptom Manage. 1991;6:53–57.PubMedCrossRefGoogle Scholar
  3. 3.
    Von Roenn JH, Cleeland CS, Gonin R, et al. Physicians’ attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Int Med. 1993;119:121–126.Google Scholar
  4. 4.
    Cherny NI, Portenoy RK. Cancer pain: principles of assessment and syndromes. In: Wall PD, Melzack R, eds. Textbook of Pain. 3rd ed. London: Churchill Livingstone. 1994;787–824.Google Scholar
  5. 5.
    Coyle N. A model of continuity of care for cancer patients with chronic pain. Med Clin N Am. 1987;71:259–270.PubMedGoogle Scholar
  6. 6.
    Levy MH. Effective integration of pain management into comprehensive cancer care. Postgrad Med J. 1991;67(suppl 2):35–43.Google Scholar
  7. 7.
    Shegda LM, McCorkle R. Continuing care in the community. J Pain Symptom Manage. 1990; 5:279–286.PubMedCrossRefGoogle Scholar
  8. 8.
    Ventafridda V. Continuing care: a major issue in cancer pain management. Pain. 1989;36:137–143.PubMedCrossRefGoogle Scholar
  9. 9.
    World Health Organization. Cancer Pain Relief and Palliative Care. Geneva: World Health Organization; 1990.Google Scholar
  10. 10.
    Gonzales GR, Elliot KJ, Portenoy RK, et al. The impact of a comprehensive evaluation in the management of cancer pain. Pain. 1991;47:141–144.PubMedCrossRefGoogle Scholar
  11. 11.
    Breitbart W. Psychiatric management of cancer pain. Cancer. 1989;63:2336–2342.PubMedCrossRefGoogle Scholar
  12. 12.
    Derogatis LR, Morrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983;249:751–757.PubMedCrossRefGoogle Scholar
  13. 13.
    Saunders C. The philosophy of terminal care. In: Saunders C, ed. The Management of Terminal Malignant Disease. 2nd ed. Baltimore: Arnold; 1984:232–241.Google Scholar
  14. 14.
    Ventafridda V, DeConno F, Ripamonti C, et al. Quality of life assessment during a palliative care program. Ann Oncol. 1990;1:415–420.PubMedGoogle Scholar
  15. 15.
    Portenoy RK. Cancer pain: pathophysiology and syndromes. Lancet. 1992;339:1026–1031.PubMedCrossRefGoogle Scholar
  16. 16.
    Amer S, Meyerson BA. Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain. Pain. 1988;33:11–23.CrossRefGoogle Scholar
  17. 17.
    Ventafridda V, Caraceni A. Cancer pain classification: a controversial issue. Pain. 1991;46:1–2.PubMedCrossRefGoogle Scholar
  18. 18.
    Devor M, Basbaum AI, Bennett GJ, et al. Group report: mechanisms of neuropathic pain following peripheral injury. In: Basbaum A, Besson J-M, eds. Towards a New Pharmacotherapy of Pain. New York: Wiley; 1991:417–440.Google Scholar
  19. 19.
    Mense S, Stahnke M. Responses in muscle afferent fibers of slow conduction velocity to contractions and ischaemia in the cat. J Physiol (Lond). 1983;342:343–348.Google Scholar
  20. 20.
    Ness TJ, Gebhart GE. Visceral pain: a review of experimental studies. Pain. 1990;41:167–234.PubMedCrossRefGoogle Scholar
  21. 21.
    Willis WD. The Pain System: The Neural Basis of Nociceptive Transmission in the Mammalian Nervous System. Basel: Karger; 1985.Google Scholar
  22. 22.
    Portenoy RK. Issues in the management of neuropathic pain. In: Basbaum A, Besson J-M, eds. Towards a New Pharmacotherapy of Pain. New York: Wiley; 1991:393–416.Google Scholar
  23. 23.
    Bonica JJ, Ventafridda V, Twycross RG. Cancer pain. In: Bonica JJ, ed. The Management of Pain. 2nd ed. Philadelphia: Lea & Febiger; 1990:400–460.Google Scholar
  24. 24.
    Banning A, Sjogren P, Henriksen H. Pain causes in 200 patients referred to a multidisciplinary cancer pain clinic. Pain. 1991;45:45–48.PubMedCrossRefGoogle Scholar
  25. 25.
    Foley KM. Clinical assessment of pain. Acta Anaesth Scand. 1982;74(suppl):91–96.CrossRefGoogle Scholar
  26. 26.
    Twycross RG, Fairfield S. Pain in far-advanced cancer. Pain. 1982;14:303–310.PubMedCrossRefGoogle Scholar
  27. 27.
    Foley KM. The treatment of cancer pain. N Engl J Med. 1985;313:84–95.PubMedCrossRefGoogle Scholar
  28. 28.
    Nielsen OS, Munro AJ, Tannock IF. Bone metastases: pathophysiology and management policy. J Clin Oncol. 1991;9:509–524.PubMedGoogle Scholar
  29. 29.
    Payne R. Pharmacological management of bone pain in the cancer patient. Clin J Pain. 1989;5(suppl 2):S43–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Wagner G. Frequency of pain in patients with cancer. Recent Results Cancer Res. 1984;89:64–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Jonsson OG, Sartain P, Ducore JM, et al. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr. 1991; 117:233–237.Google Scholar
  32. 32.
    Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3:40–51.PubMedCrossRefGoogle Scholar
  33. 33.
    Sorensen S, Borgesen SE, Rohde K, et al. Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer. 1990;65:1502–1508.PubMedCrossRefGoogle Scholar
  34. 34.
    Constans JP, DeVitis E, Donzelli R, et al. Spinal metastases with neurological manifestations: review of 600 cases. J Neurosurg. 1983;59:111–118.PubMedCrossRefGoogle Scholar
  35. 35.
    Phillips E, Levine AM. Metastatic lesions of the upper cervical spine. Spine. 1989;14:1071–1077.PubMedCrossRefGoogle Scholar
  36. 36.
    Sundaresan N, Galicich JH, Lane JM, et al. Treatment of odontoid fractures in cancer patients. J Neurosurg. 1981;54:187–192.PubMedCrossRefGoogle Scholar
  37. 37.
    Bosley TM, Cohen DA, Schatz NJ, et al. Comparison of metrimazole computed tomography with magnetic resonance imaging in the evaluation of lesions at the cervicomedullary junction. Neurology. 1985;35:485–492.PubMedCrossRefGoogle Scholar
  38. 38.
    Posner JB. Back pain and epidural spinal cord compression. Med Clin N Am. 1987;71:185–206.PubMedGoogle Scholar
  39. 39.
    Barcena A, Lobato RD, Rivas JJ, et al. Spinal metastatic disease: analysis of factors determining functional prognosis and choice of treatment. Neurosurgery. 1984;15:820–827.PubMedCrossRefGoogle Scholar
  40. 40.
    Portenoy RK, Galer BS, Salamon 0, et al. Identification of epidural neoplasm. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine. Cancer. 1989;64:2207–2213.PubMedCrossRefGoogle Scholar
  41. 41.
    Ruff RL, Lanska DJ. Epidural metastases prospectively evaluated in veterans with cancer and back pain. Cancer. 1989;63:2234–2241.PubMedCrossRefGoogle Scholar
  42. 42.
    Grant R, Papadopoulos SM, Greenberg HS. Metastatic epidural spinal cord compression. Neurolog Clin. 1991;9:825–841.Google Scholar
  43. 43.
    Harrington KD. Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg. 1984;61:107–117.PubMedCrossRefGoogle Scholar
  44. 44.
    Sundaresan N, Galicich JH, Lane JM, et al. Treatment of neoplastic epidural cord compression by vertebral resection and stabilization. J Neurosurg. 1985;63:676–684.PubMedCrossRefGoogle Scholar
  45. 45.
    Portenoy RK, Lipton RB, Foley KM. Back pain in the cancer patient: an algorithm for evaluation and management. Neurology. 1987;37:134–138.PubMedCrossRefGoogle Scholar
  46. 46.
    Hagen N, Stulman J, Krol G, et al. The role of myelography and magnetic resonance imaging in cancer patients with symptomatic and asymptomatic epidural disease. Neurology. 1989;39:309.CrossRefGoogle Scholar
  47. 47.
    Stark RJ, Henson RA, Evans SJW. Spinal metastases: a retrospective survey from a general hospital. Brain. 1982;105:189–197.PubMedCrossRefGoogle Scholar
  48. 48.
    DeLattre JY, Arbit E, Thaler HT, et al. A dose response study of dexamethasone in a model of spinal cord compression caused by epidural tumor. J Neurosurg. 1989;70:920–925.PubMedCrossRefGoogle Scholar
  49. 49.
    Greenberg HS, Kim J, Posner JB. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol. 1980;8:361–366.PubMedCrossRefGoogle Scholar
  50. 50.
    Vecht CJ, Haaxma-Reiche H, van Putten WLJ, et al. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology. 1989;39:1255–1257.PubMedCrossRefGoogle Scholar
  51. 51.
    Rodichok LD, Harper GR, Ruckdeschel JC, et al. Early diagnosis of spinal epidural metastases. Am J Med. 1981;70:1181–1184.PubMedCrossRefGoogle Scholar
  52. 52.
    Graus F, Krol G, Foley KM. Early diagnosis of spinal epidural metastasis: correlation with clinical and radiological findings. Proc Am Soc Clin Oncol 5. 1986: Abstract 1047.Google Scholar
  53. 53.
    O’Rourke T, George CB, Redmond J. Spinal computed tomography and computer tomographic metrimazide myelography in the early diagnosis of spinal metastatic disease. J Clin Oncol. 1986;4:576–581.PubMedGoogle Scholar
  54. 54.
    Sim FH. Metastatic bone disease: lesions of the pelvis and hip. In: Sim FH, ed. Diagnosis and Management of Metastatic Bone Disease. A Multidisciplinary Approach. New York: Raven Press; 1988:183–198.Google Scholar
  55. 55.
    Beatrous TE, Choyke PL, Frank JA. Diagnostic evaluation of cancer patients with pelvic pain: comparison of scintigraphy, CT, and MR imaging. Am J Roentgen. 1990;155:85–88.Google Scholar
  56. 56.
    Forsyth PA, Posner JB. Headache associated with intracranial neoplasms. In: Olesen J, Tfelt-Hansen P, Welch KMA, eds. The Headaches. New York: Raven Press. 1993;705–714.Google Scholar
  57. 57.
    Fadul C, Misulis KE, Wiley RG. Cerebellar metastases: diagnostic and management considerations. J Clin Oncol. 1987;5:1110–1115.Google Scholar
  58. 58.
    Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:575–587.Google Scholar
  59. 59.
    Greenberg HS, Deck MDF, Vikram B, et al. Metastasis to the base of the skull: clinical findings in 43 patients. Neurology. 1981;31:530–537.PubMedCrossRefGoogle Scholar
  60. 60.
    Bingas B. Tumors of the base of the skull. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Amsterdam: Elsevier; 1974;17:136–233.Google Scholar
  61. 61.
    Bullitt E, Tew JM, Boyd J. Intracranial tumors in patients with facial pain. J Neurosurg. 1986;64:865–871.PubMedCrossRefGoogle Scholar
  62. 62.
    Silen W. Cope’s Early Diagnosis of the Acute Abdomen. 16th ed. New York: Oxford; 1983.Google Scholar
  63. 63.
    Coombs DW. Pain due to liver capsular distention. In: Ferrer-Brechner T, ed. Common Problems in Pain Management. Common Problems in Anesthesia. Chicago: Year Book Medical Publishers; 1990:247–253.Google Scholar
  64. 64.
    Mulholland MW, Debas H, Bonica JJ. Diseases of the liver, biliary system and pancreas. In: Bonica JJ, ed. The Management of Pain. Philadelphia: Lea & Febiger, 1990;2:1214–1231.Google Scholar
  65. 65.
    Baines MJ. Management of malignant intestinal obstruction in patients with advanced cancer. In: Foley KM, Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy: Second International Congress on Cancer Pain. New York: Raven Press; 1990;16:327–336.Google Scholar
  66. 66.
    Ventafridda V, Ripamonti C, Caraceni A, et al. The management of inoperable gastrointestinal obstruction in terminal cancer patients. Tumori. 1990;76:389–393.PubMedGoogle Scholar
  67. 67.
    Bender MD. Diseases of the peritoneum, mesentery and diaphragm. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal Disease: Pathophysiology,Diagnosis, Management. 4th ed. Philadelphia: Saunders; 1989:1932–1967.Google Scholar
  68. 68.
    Lynch MA, Cho KC, Jeffrey RI, et al. CT of peritoneal lymphomatosis. Am J Roentgen. 1988; 151:713–715.Google Scholar
  69. 69.
    Stillman M. Perineal pain: diagnosis and management, with particular attention to perineal pain of cancer. In: Foley KM, Bonica JJ, Ventafridda V, eds. Advances in Pain Research and Therapy: Second International Congress on Cancer Pain. New York: Raven Press; 1990;16:359–377.Google Scholar
  70. 70.
    Seefeld PH, Bargen JA. The spread of carcinoma of the rectum: invasion of lymphatics, veins and nerves. Ann Surg. 1943;118:76–90.PubMedGoogle Scholar
  71. 71.
    Sinaki M, Merritt JL, Stilwell GK. Tension myalgia of the pelvic floor. Mayo Clin Proc. 1977; 52:717–722.PubMedGoogle Scholar
  72. 72.
    Fair WR. Urologic emergencies. In: DeVita VT, Hellman S, Rosengerg SA, eds. Cancer Principles and Practice of Oncology. 3rd ed. Philadelphia: Lippincott; 1989:2016–2028.Google Scholar
  73. 73.
    Greenfield A, Resnick MI. Genitourinary emergencies. Semin Oncol. 1989;16:516–520.PubMedGoogle Scholar
  74. 74.
    Talner LB. Specific causes of obstruction. In: Pollack HM, ed. Clinical Urography. Philadelphia: Saunders; 1990;2:1629–1751.Google Scholar
  75. 75.
    Cantwell BM, Richardson PG, Campbell SJ. Gynaecomastia and extragonadal symptoms leading to diagnosis delay of germ cell tumours in young men. Postgrad Med J. 1991;67:675–677.PubMedCrossRefGoogle Scholar
  76. 76.
    Hands LJ, Greenall MJ. Gynaecomastia. Br J Surg. 1991;78:907–911.PubMedCrossRefGoogle Scholar
  77. 77.
    Tseng AJ, Horning SJ, Freiha FS, et al. Gynecomastia in testicular cancer patients. Prognostic and therapeutic implications. Cancer. 1985;56:2534–2538.PubMedCrossRefGoogle Scholar
  78. 78.
    Chrisp P, Sorkin EM. Leuprorelin. A review of its pharmacology and therapeutic use in prostatic disorders. Drugs Aging. 1991;1:487–509.PubMedCrossRefGoogle Scholar
  79. 79.
    Eberlein TJ. Gynecomastia. In: Harris JR, Hellman S, Henderson IC, Kinne D, eds. Breast Diseases. Philadelphia: Lippincott; 1991:46–50.Google Scholar
  80. 80.
    Delaere KP, Van Thillo E. Flutamide monotherapy as primary treatment in advanced prostatic carcinoma. Semin Oncol. 1991;5:13–18.Google Scholar
  81. 81.
    Buchi K. Radiation proctitis: therapy and prognosis. JAMA. 1991; 265:1180.PubMedCrossRefGoogle Scholar
  82. 82.
    Earnest DL, Trier JS. Radiation enteritis and colitis. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal Disease: Pathophysiology,Diagnosis, Management. Philadelphia: Saunders; 1989;2:1369–1382.Google Scholar
  83. 83.
    Epstein JB, Wong FLW, Stephenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg. 1987;45:104–110.PubMedCrossRefGoogle Scholar
  84. 84.
    Epstein JB, Schubert MM, Scully C. Evaluation and treatment of pain in patients with orofacial cancer. Pain Clin. 1991;4:3–20.Google Scholar
  85. 85.
    Portenoy RK. Evaluation of back pain in the patient with cancer. J Back Pain Musculoskel Rehab. 1993;3:44–52.Google Scholar

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© Springer Science+Business Media New York 1997

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  • Russell K. Portenoy

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