Nessa Coyle, RN, MS

People living with cancer may experience nerve pain often described as tingling, burning, or numbness. Problems with coordination also may be present. These symptoms may be associated with a peripheral neuropathy. In this condition, nerves outside the brain and spinal cord have been damaged, often by the cancer treatments themselves.

Palliative care is an integral part of comprehensive cancer care. Every oncology nurse, regardless of specialty, integrates elements of palliative care into daily practice-whether meeting a newly diagnosed patient for the first time or helping a patient and family through the final phase of life.

The intent of this article is to provide oncology nurses with practical information on the pharmacologic management of pain. The use of chemotherapy, radiation therapy, and surgery in pain management will not be addressed in this article. It is the second in a three-part series on cancer pain management. The first in the series (September 2006) addressed cancer pain assessment. In a future issue, the third in the series will address nonpharmacologic approaches to cancer pain management.

The high prevalence of pain in the cancer population underscores why pain management is integral to comprehensive cancer care. How well pain is controlled can have a profound effect on the cancer experience for both patient and family. The goals of pain assessment are to prevent pain if possible, and to identify pain immediately should it occur. This can be facilitated by standardized screening of all cancer patients for pain, on a routine basis, across care settings. A comprehensive assessment of pain follows if a patient reports pain that is not being adequately managed. Oncology nurses play a huge role in pain assessment and management throughout the course of a patient's disease. A basic understanding of the types of pain seen in the cancer population as well as inferred neurophysiologic pain mechanisms and temporal patterns of pain can help focus the pain assessment. This in turn will lead to targeted pain management strategies

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient’s