Management of cancer pain: an overview.

This paper provides an overview of the current status of the management of cancer pain. The concept of "total care" of the patient with cancer incorporates an effort to eradicate or suppress the underlying malignancy, but when this is no longer feasible emphasis is shifted to symptom control to maximize the quality of remaining life. Even though the malignancy cannot be eradicated, an important first step in pain control is the diagnostic identification of the source of pain because it is preferable to treat the pain specifically rather than symptomatically. Alleviation of the patient's "total agony" requires treatment of the emotional as well as the physical component of pain. In addition, successful management is facilitated by attention to the social needs of both patient and family. Pharmacological therapy is the keystone of pain management; this includes the use of psychotropic agents and narcotic analgesics given orally on a regular schedule to prevent pain, rather than treating the pain after it has appeared. The hospice approach embodies the principles of pharmacological therapy and social, spiritual, and emotional support for the patient and family. These noninvasive methods have been shown to be effective in an increasing proportion of patients with advanced cancer, resulting in a decline in the need for neurosurgical intervention. However, in some patients conservative management fails and neurosurgical intervention should be considered. For those who are candidates for neurosurgical intervention, a wide variety of procedures is available. The selection of specific procedures depends on the source and severity of the pain and on the life expectancy and general condition of the patient.