Medical experts estimate that about half of all patients with cancer, and 75 to 90 percent of patients with advanced cancer, experience pain. Of those patients who say they have pain, about 50 percent describe the pain as moderate to severe.  Cancer can trigger pain in different ways. The tumor may grow into bones, nerves and other organs, which can cause mild to severe pain.  Some cancer treatments, such as surgery, radiation, and chemotherapy can cause pain as well.

Many cancer patients continue to experience severe pain needlessly due to underassessment and treatment.

The Joint Commission on Hospital Accreditation has called for better pain assessment and treatment calling pain the "5^th Vital Sign."  This increased awareness of the importance of pain treatment is growing in momentum, yet patients and their families find they must be the ones to broach the subject with their doctors, nurses and other health-care providers.

A comprehensive approach to treating cancer pain can improve a person's quality of life.  Doctors typically use one or several measuring tools, such as a 0-10 pain rating scale, to gauge the severity and impact of cancer pain.  By obtaining an in-depth pain history, a health-care provider can design the most appropriate pain treatment regime.

A good starting point in cancer pain treatment is the simple, three-step, pain-relieving "ladder" developed in 1990 by the World Health Organization (WHO) to help guide doctors and other health-care providers who manage pain.  The ladder employs increasingly powerful pain-relieving treatments as a patient's pain increases.  It starts with non-opioid treatments for lower-level pain, adds opioids as pain persists or increases, and finally moves to the strongest opioids coupled with other treatments for "level-three," or most severe, pain.  The ladder approach can provide effective pain relief for up to 90 percent of patients, according to WHO estimates.

Two elements are critical for the successful treatment of cancer pain—one being the patient and the other the health care provider.  The patient must insist that their pain complaints are clearly communicated.  Don't be afraid to ask for good pain assessment and treatment.  If the treatment is ineffective, relay this information back to the physician for alternatives.  If your pain treatment is not effective, seek treatment from a Pain Medicine physician, particularly one who has completed board certification in the field of Pain Medicine.  You may find Pain Medicine specialists in your area by going to the Web sites of the American Board of Anesthesiologists (https://secure.abanes.org/portal/WhosCertified.asp), the American Board of Pain Medicine (http://www.abpm.org/diplomates/index.html), or the American Board of Hospice and Palliative Care Medicine (http://www.abhpm.org/Locator.aspx).

Physicians who are sub-specialists in Pain Medicine may be found in the fields of anesthesiology, physical medicine and rehabilitation, psychiatry, neurology, or palliative care. 

Consider keeping a Personal Pain Journal to learn more about your personal pain patterns and remedies that have worked in the past.  This knowledge can help you and your health provider develop the pain management plan that works best for you. 

A rehabilitation approach that combines aggressive pain control with physical therapy and behavioral support also may help. Pain and cancer treatment centers may offer these programs for cancer patients.  Or, you may find such programs at a rehabilitation center in your area. 

These programs may include:

• Assessment of physical and psychosocial function, presence of disability and rehabilitation needs.
• Recommendations regarding appropriate interventions, including medications, physical, occupational, speech and other therapies, nursing care and patient education.
• Recommendations regarding appropriate level of care, including transfer to an inpatient rehabilitation unit or other post-acute-care options.
• Daily medical care for patients transferred to the inpatient rehabilitation unit.  
• Recommendations regarding adaptive equipment, orthotics or prosthetics and outpatient support services.
• Treatment of musculoskeletal and soft tissue pain using joint and trigger point injections, medical acupuncture and muscle energy techniques, as well as medications and other therapies.

Regardless of the place you receive treatment, the key to success is the attitude and knowledge of your physician.  Be sure your doctor is comfortable focusing on pain control and in using the various medications needed for effective pain management.

A major goal of The National Pain Foundation is to provide useful and up-to-date information about pain conditions. Explore this site for information on how to manage cancer pain.