Principles of managing cancer pain in palliative care

Pain is a common complication of cancer—it is experienced by 3 out of 4 people with advanced disease and may be related to:

• The cancer itself (eg peritumour oedema and inflammation, bone metastases)
• cancer treatment (eg peripheral neuropathy, radiation-induced skin reactions, surgery-induced neuropathic pain)
• concurrent illness or injury (eg infection, paraneoplastic syndromes).

For patients with cancer, follow the approach to pain management outlined in Approach to managing pain in palliative care, but also consider additional palliative management strategies such as radiotherapy and anticancer drugs. Seek early consultation with a radiation oncologist, particularly for patients with bone pain.

Although evidence to support or refute the use of paracetamol for cancer pain is lacking, it is often trialled to see if there is benefit because of its favourable safety profile at therapeutic doses.

The role of opioids in patients who have lived with cancer as a chronic illness and cancer survivors (people who are in remission or cured) has not been well established. Consider the principles of managing pain in patients who have pre-existing chronic noncancer pain in palliative care when using opioids for cancer pain management in these patients.

For principles of palliative care for patients with cancer, see Principles of palliative care for patients with cancer.