Overview of assessing a patient with cancer pain

Pain is a common complication of cancer—it is experienced by approximately half of people with a recent cancer diagnosis and three out of four people with advanced disease. Patients often simultaneously experience acute and chronic pain, which may be related to:

• the cancer itself (eg tumour invasion of visceral organs, bone and major nerves)
• cancer treatment (eg chemotherapy-induced mucositis, colitis, peripheral neuropathy, radiotherapy-induced dermatitis, surgery-induced neuropathic pain, postamputation pain)
• concurrent illness or injury (eg infection, paraneoplastic syndromes, nonmalignant causes).

Pain may also be experienced by people living with cancer as a chronic illness and cancer survivors (people who are in remission or cured).

The approach to assessing a patient with cancer pain is similar to that for noncancer pain but additional attention to the sociopsychobiomedical contributors to pain may be needed. In particular, be mindful that:

• pain (and the need for opioid analgesia) may be perceived by patients or their families as a sign of treatment failure or disease progression
• a patient’s experience of pain may be affected by the physical, emotional, social, existential and spiritual challenges associated with a cancer diagnosis.

When the goals of care are palliative, also see Principles of managing pain in palliative care.