Cancer Pain Management

Pain is a common symptom experienced by patients with cancer from diagnosis through survivorship and is characterized as being acute, chronic, breakthrough, and refractory or intractable. Whether as a result of a disease or disease-related treatment, cancer pain causes significant physical and psychosocial burdens. A uniquely personal experience, pain markedly affects the quality of an individual’s life, increases vulnerability in an already vulnerable population, and engenders dependence on healthcare providers for access to adequate pain management (Aman et al., 2021; Fallon et al., 2018; National Comprehensive Cancer Network, 2022). As members of interprofessional teams involved in practice, education, administration, and research, oncology nurses are in a pivotal position to improve cancer pain management.

It is the position of ONS that

• Cancer pain prevention and culturally relevant and sensitive pain assessment, education, and management are essential elements of quality cancer care throughout all phases of the cancer care continuum.
• Comprehensive cancer pain management is an interprofessional and collaborative effort that will include screening for pain at each encounter, ongoing assessment, and planning, intervention, and evaluation of pain and pain relief. It addresses physical, psychological, spiritual, and sociocultural effects of unrelieved pain and includes the use of pharmacologic and nonpharmacologic treatment for pain.
  • Assessment includes the use of evidence-based, reliable assessment tools with a goal of capturing and documenting patient-reported pain outcomes. Patient self-report is the standard of care for evaluating pain. Vulnerable populations (e.g., young children, patients with learning disabilities or who are cognitively impaired) require special considerations for assessment of pain.
  • Education of the patient and supporting family and friends focuses on pain assessment, intervention, and management, including the risks and benefits of long-term opioid therapy and the safe storage, use, and disposal of controlled substances.
  • Cancer survivors are at risk for long-term cancer pain syndromes after conclusion of treatment; pain assessment and, when possible, management with conservative strategies, will be adopted for this patient population.
• Healthcare systems and clinicians providing care to patients with cancer are responsible for adopting and monitoring institutional and clinical guidelines for cancer pain management and symptoms related to its treatment. Healthcare systems will establish mechanisms for continuous evaluation of pain outcomes in patients at risk for cancer pain.
• Strategies to reduce or remove regulatory, legislative, economic, and other barriers to effective cancer pain management will be implemented.
• All healthcare professionals caring for patients with cancer have an ethical responsibility to acquire and use current knowledge and skills, free from bias, to assess cancer pain and implement evidence-based pain management guidelines while being good stewards of pain treatment options, especially in the use of opioids.

Approved by the ONS Board of Directors April 1998. Revised November 2000, June 2002, October 2004, October 2006, January 2010, January 2013, January 2014, January 2015, January 2016, October 2017, March 2019, May 2022.

Download this position statement.

References 

Aman, M.M., Mahmoud, A., Deer, T., Sayed, D., Hagedorn, J.M., Brogan, S.E., . . . Narang, S. (2021). The American Society of Pain and Neuroscience (ASPN) best practices and guidelines for the interventional management of cancer-associated pain. Journal of Pain Research, 14, 2139–2164. https://doi.org/10.2147/jpr.S315585

Fallon, M., Giusti, R., Aielli, F., Hoskin, P., Rolke, R., Sharma, M., & Ripamonti, C.I. (2018). Management of cancer pain in adult patients: ESMO clinical practice guidelines. Annals of Oncology, 29(Suppl. 4), iv166–iv191. https://doi.org/10.1093/annonc/mdy152

National Comprehensive Cancer Network. (2022). NCCN Clinical Practice Guidelines: Adult cancer pain [v.1.2022]. http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf