Assessment of cancer pain: a continuous challenge.

A comprehensive assessment of cancer pain is the first and perhaps most important step toward pain relief. Yet, this assessment is frequently neglected in patients with cancer pain. This paper addresses five important aspects of cancer pain assessment: (1) What constitutes cancer pain assessment? (2) Why is it important? (3) Why is it frequently overlooked? (4) How can a cancer pain assessment program be implemented? (5) What changes can be expected as a result of routine cancer pain assessments? The fundamental assumptions underlying this discussion are that health-care providers must understand the intensity of their patients' pain and the likely etiology of that discomfort to direct an appropriate diagnostic evaluation and to initiate and evaluate the success of therapy. Instituting a routine pain assessment program need not be difficult. The recommended procedures must be simple, quantifiable, relevant, and recorded in the medical record. Routine pain assessment will promote a heightened sense of awareness and responsibility about cancer pain issues in health-care providers, improved communication between the patient and the health-care provider, the development of cancer pain quality-assurance programs, and improved care for patients with cancer and pain.