Cancer pain management in the hospice setting.

Pain relief for the cancer patient in the hospice setting is almost always achievable. Cancer pain is caused by tumor growth and by psychosocial and spiritual factors. Opioid drugs are the mainstay of effective treatment. Morphine is the opioid drug of choice. Although tolerance to opioids occurs, tumor growth is the usual reason for escalating opioid dose. Addiction almost never occurs in the cancer patient with pain. These patients don't exhibit drug-seeking behavior or experience the psychic high seen in drug addicts. Nonsteroidal anti-inflammatory drugs and adjuvant analgesics are synergistic with opioids in providing analgesia and allow lower opioid doses and fewer side effects. Ten to 15 percent of hospice patients will require regional anesthesia for pain relief. The hospice team of physicians, nurses, social workers, chaplains, aides, and volunteers is more effective than any single health care provider in achieving optimal pain relief and comfort.