Difficult problems and their solutions in patients with cancer pain of the head and neck areas.

Pain management can be especially difficult in patients with head and neck cancer due to the erosive nature of the neoplasms that invade the region, the rich innervation of the head and neck, and other factors. Consequently, diagnosis is a complex process that cannot be dealt with in a cursory fashion. Furthermore, tumor pain can mimic noncancer conditions, nonmalignant orofacial disorders can be suggestive of tumor growth, and antineoplastic treatment-related conditions can be difficult to distinguish from tumor recurrence. A series of case reports illustrates key elements of diagnosis and pain management in patients with head and neck cancer. These elements include 1) detailed assessment of pain intensity and characteristics; 2) appropriate use of analgesic adjuvant medications; 3) use of diagnostic and therapeutic nerve blocks and myofascial trigger point injections; and 4) a high index of suspicion regarding tumor recurrence pain.