A Guide for Pain Management in Developing Nations: The Diagnosis and Assessment of Pain in Cancer Patients

• Joseph V. Pergolizzi

  Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA 2Department of Anesthesiology, Georgetown University School of Medicine, Washington, D.C., USA 3Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA

• Gianpietro Zampogna

  NEMA Research, Naples, Florida, USA

• Robert Taylor

  NEMA Research, Naples, Florida, USA

• Marixa Guerrero

  Medical Director of Instituto de Ortopedia Roosevelt, Bogota, Colombia

• Juan Quillermo Santacruz

  Palliativist of Fundacion Santa fe, Bogota, Colombia

• Robert B. Raffa

  Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA

 The fundamental approach to cancer patients with pain is to identify the pain sites, and describe, quantify, and categorize the pain by type at each site. There are many validated tools to serve the clinician in these efforts, particularly for pain assessment. Multimechanistic pain syndromes are common in cancer patients. Cancer patients may experience nociceptive pain. They may also experience neuropathic pain due to chemotherapy-induced or cancer-related nerve damage. Analgesic choices must be guided by the pain mechanisms, nature, and severity of the pain, comorbid conditions, and patient characteristics. Long-acting opioid analgesics or fixed-clock dosing can eliminate end-of-dose analgesic gaps. The potential for opioid abuse is an important public health challenge but one that should not undermine the appropriate treatment of moderate to severe cancer pain. Abuse-deterrent opioid formulations can be useful. Care is needed for special populations of cancer patients dealing with pain, such as geriatric, pediatric, or obese patients. While morphine has long been the gold standard of oral opioid products, recent clinical trials suggest that oral hydrocodone and oral oxycodone may offer advantages over oral morphine. Patient adherence is crucial for adequate analgesia and patient education can promote adherence and manage expectations.

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