Pain and Symptom Management

  • C. S. Cleeland
  • E. Bruera
Part of the UICC International Union Against Cancer book series (UICCI)


Approximately half of patients with cancer cannot be cured of their disease; of these over two-thirds will suffer significantly with pain before death. For most patients most of the time, pain from cancer can be adequately controlled with analgesics given by mouth. Where this is not possible, a variety of more sophisticated pain management techniques can provide control, and it is estimated that approximately 95% of patients could be free of significant pain, at least until the last week or two of life. Unfortunately, many patients who develop pain do not actually achieve adequate pain control. Estimates based on surveys in the United States indicate that only 40% of all cancer patients with pain obtain optimal pain control. In countries with fewer medical resources, the vast majority of patients may have unrelieved pain. Poorly controlled pain has such deleterious effects on the patient and his or her family that proper management of pain must have the highest priority for those who routinely care for cancer patients. Not only do mood and quality of life deteriorate in the presence of pain, but pain has adverse effects on such measures of disease status as appetite and activity. Severe pain may be a primary reason why both patients and their families decide to stop active treatment. Greater awareness of how to anticipate, evaluate, and treat pain will benefit many patients.


Cancer Pain Oral Morphine Morphine Sulfate Nonopioid Analgesic Adequate Pain Control 
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Further Reading

  1. Cleeland CS (1984) The impact of pain on the patient with cancer. Cancer 54: 2635–2641PubMedCrossRefGoogle Scholar
  2. Cleeland CS, Gonin R, Hatfield AK et al. (1994) Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine 330: 592–596PubMedCrossRefGoogle Scholar
  3. Doyle D, Hanks GWC, McDonald N (eds) (1993) Oxford textbook of palliative medicine. Oxford University Press, OxfordGoogle Scholar
  4. Foley KM (1985) The treatment of cancer pain. New England Journal of Medicine 313 (2): 84–95PubMedCrossRefGoogle Scholar
  5. Jacox A, Carr DB, Payne R (1994) New clinical-practice guidelines for the management of pain in patients with cancer. New England Journal of Medicine 330: 651–655PubMedCrossRefGoogle Scholar
  6. Portenoy RK (1989) Cancer pain: epidemiology and syndromes. Cancer 63: 2298PubMedCrossRefGoogle Scholar
  7. Weissman DE, Burchman SL, Dinndorf PA and Dahl JL (1993) Handbook of Cancer Pain Management, 4th edition, The Wisconsin Cancer Pa in Initiative.Google Scholar
  8. World Health Organization (1986) Cancer pain relief. WHO, GenevanGoogle Scholar
  9. World Health Organization (1990) Cancer pain relief and palliative care. WHO, GenevanGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • C. S. Cleeland
  • E. Bruera

There are no affiliations available

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