A Cancer Pain Tutorial

A Comprehensive Visual Short Course
on Cancer Pain Management

Assessment of Pain
physican and patient
Studies show that one of the major barriers in delivering adequate pain management to cancer patients is a poor understanding of pain assessment by physicians. Pain should be evaluated as any other medical problem is: in an organized, comprehensive, methodical way. A strategy for approaching pain assessment is listed here:
  1. Detailed History
  2. Review of Physiologic Systems
  3. Physical Examination
  4. Psychosocial Assessment
  5. Diagnostic Evaluation
  6. Family Conference
  7. Reassessment
list of  medical and oncolgy history areas

The detailed history should include a review of current medical record, including radiological studies.

Past medical history covering the presence of concomitant illnesses, current medications used, current use of vitamins or natural food products, allergies to medications, prior medical illnesses no longer under treatment, and surgical history (exclusive of oncologic illnesses).

An oncologic history should cover the diagnosis and evolution of disease, history of therapy to the present, side effects of therapy, and the patient's understanding of the disease, its therapy, and its prognosis.

picture of a rack
list of areas of pain history
Pain history includes pre-morbid chronic pain, pre-morbid drug or alcohol use, vitamins and natureopathies, and evaluation of each pain. In the next section each physiologic system is hot linked for searching up to date standards of practice.
aniamtion of system review
picture of a physical examination
list of items to cover in a physical exam

Standard procedures for a complete physical examination are used. Careful attention to the neurological examination is essential. Evaluate for sensory and motor deficits. Look for signs of spinal cord compression (hyperreflexia, bladder or bowel dysfunction or sensory or motor loss). Carefully record all pertinent findings.

picture of a person painting
list of items for psychosocial assessment

The Psychosocial Assessment should include:

  1. Marital History
  2. Residential Status (who is living in the home)
  3. Employment history and employment status
  4. Educational background
  5. Functional status (activities of daily living, can they focus, sleep, eat?)
  6. Recreational activities
  7. Support system (identify the primary care giver), and capabilities of spouse/significant other
bone scan
chest x-ray
head MRI
head ct
list of diagnostic tests

Laboratory tests may be necessary to arrive at a proper pain diagnosis and to formulate strategies for intervention.

It may be necessary to acquire appropriate imaging studies before formulating a plan of intervention, since without a proper diagnosis, appropriate interventions cannot be recommended.

picture-review of a case
list of items for family conference
picture of a calendar

Reassessment of symptoms is an integral part of managing cancer pain. Changes in the patient's current pain patterns develop.

New pains that develop should trigger a diagnostic evaluation and a modification of the treatment plan.