Evaluating Pain in Patient with Cancer

 

Establish the type and severity of the pain:

(1) believe the patient's complaint of pain (unless there is evidence not to)

(2) determine when the pain occurs, its intensity and its duration

(3) try to characterize the pain

(4) identify factors that may trigger the pain

(5) identify factors that make the pain better or worse

(6) need for immediate pain control to facilitate the evaluation

 

Perform a complete evaluation:

(1) history, including a history of drug or alcohol abuse

(2) review of systems

(3) review of current medications, diet and activity level

(4) physical examination

(5) laboratory assessment, paying attention to renal and hepatic function

(6) imaging studies as needed

(7) impact of pain on patient and family, especially psychological distress (anxiety, depression, etc)

(8) coping strategies used by the patient and family

(9) compliance with instructions and adherence to medications

 

Try to determine:

(1) probable explanation(s) for the pain

(2) effectiveness of current pain management and any problems

(3) factors that may affect the effectiveness of pain medication (altered metabolism, opioid tolerance, disease progression, somatization, etc)

(4) adverse effects of pain medications

(5) resources that might be needed to alleviate the pain

 

Develop a strategy to manage the pain:

(1) Establish reasonable treatment goals.

(2) Discuss the pain and management plan with the patient, obtaining informed consent.

(3) Provide disease-specific therapy whenever possible.

(4) Adjust dosages to take into account age, other medications and comorbid conditions.

(5) Be prepared to rotate analgesics to optimize analgesia and to minimize adverse effects.

(6) Institute strategies to minimize adverse effects (constipation, etc).

(7) Provide the patient and family with some sense of control.

(8) Monitor the program for effectiveness.