About 8 million Americans now have cancer or a history of cancer; half of these diagnoses were made within the past 5 years. Cancer causes 1 of every 10 deaths worldwide (Stjernsward and Teoh, 1990) and is increasingly prevalent in the United States where it causes 5 deaths-about 1,400 per day (American Cancer Society, 1992).
Pain associated with cancer is frequently undertreated in adults (Bonica, 1990) and children (Miser, Dothage, Wesley, et al., 1987). Patients with cancer often have multiple pain problems (Coyle, Adelhardt, Foley, et al., 1990). Cancer pain may be due to (1) tumor progression and related pathology (e.g., nerve damage), (2) operations and other invasive diagnostic or therapeutic procedures, (3) toxicities of chemotherapy and radiation, (4) infection, or (5) muscle aches when patients limit physical activity (Foley, 1979). The incidence of pain in patients with cancer depends on the type and stage of disease. At the time of diagnosis and at intermediate stages, 30 to 45 percent of patients experience moderate to severe pain (Daut and Cleeland, 1982). On average, nearly 75 percent of patients with advanced cancer have pain. Of cancer patients with pain, 40 to 50 percent report it as moderate to severe, and another 25 to 30 percent describe it as very severe (Bonica, 1990).
In approximately 90 percent of patients, cancer pain can be controlled through relatively simple means (Goisis, Gorini, Ratti, et al., 1989; Schug, Zech, and Dorr, 1990; Teoh and Stjernsward, 1992; Ventafridda, Caraceni, and Gamba, 1990), yet a consensus statement from the National Cancer Institute Workshop on Cancer Pain indicated that the "undertreatment of pain and other symptoms of cancer is a serious and neglected public health problem" (National Cancer Institute, 1990). The Workshop concluded that "...every patient with cancer should have the expectation of pain control as an integral aspect of his/her care throughout the course of the disease" (National Cancer Institute, 1990 ) .
Because cancer pain control is a problem of international scope, the World Health Organization (WHO) has urged that every nation give high priority to establishing a cancer pain relief policy (Stjernsward and Teoh, 1990). In the United States, many organizations have worked toward this goal (Ad Hoc Committee on Cancer Pain of the American Society of Clinical Oncology, 1992; American Pain Society, 1986; Health and Public Policy Committee, American College of Physicians, 1983; McGiveney and Crooks, 1984; Spross, McGuire, and Schmitt, 1990a, 1990b, 1990c; Weissman, Burchman, Dinndoa, 1988).
Importance of Controlling Cancer Pain
Assessment of Common Cancer Pain Syndromes
Bone Metastases
PlexoPathies
Peripheral Neuropathies
Patient Education Program Content
How to Find Local Support Groups
Pain Management (Children)
Payne on Pain
Index