Principles of cancer pain management: An overview and focus on pharmacological and interventional strategies

BACKGROUND: Pain remains one of the most significant symptoms of cancer. Impeccable assessment and understanding of the cause and mechanism of pain, pragmatic prescribing (including avoiding dogmatic opioid dose increments) and consideration of all modalities of interventions are central to optimal treatment. OBJECTIVES: This paper outlines aspects of cancer pain assessment, provides a mechanistic framework to facilitate analysis and guide treatment, and emphasises the need for ongoing assessment of treatment efficacy and toxicities. We discuss pharmacological and interventional treatment options and some cancer pain syndromes. DISCUSSION: Management of cancer pain should be proactive and driven by an understanding of pain mechanisms, cancer behaviour and trajectories. It should include optimal use of multimodality interventions alongside directed anti-cancer therapies as appropriate, in consultation with pain or palliative medicine physicians.