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Cancer-related pain may be experienced by 50% to 90% of patients with cancer.1 Cancer pain shares the same neuropathophysiological pathways as non-cancer pain; however, it rarely presents as a pure neuropathic, visceral, or somatic pain syndrome. Rather, it may involve inflammatory, neuropathy, ischemic, and compression mechanisms in multiple sites. Cancer pain may be attributed to tumor progression and invasion, cancer-related surgeries and therapeutic procedures, antineoplastic chemotherapy, hormone therapy, or radiotherapy, cancer-related infections, and musculoskeletal complaints related to inactivity and generalized fatigue.2 Cancer survivors may have persistent pain as a result of the disease or its treatment.3 Not only affecting quality of life, but also being an important predictor of survival, cancer pain is considered to be a pathogen that can further the progression of metastatic disease.4,5

Cancer pain is strongly associated with psychological distress.4,6 This association is evident across the disease spectrum, from relatively healthy outpatients to those at the end of life.2 Pain from cancer and its treatments can result in anxiety, depression, fear, anger, helplessness, and hopelessness. Uncertainty not only about the disease, but also about the duration of pain can increase emotional distress. High levels of depression and anxiety related to a cancer diagnosis, cancer pain, or treatment side effects can influence the pain experience and can increase the level of suffering. Anxiety and tension can heighten sympathetic nervous system activity, which can lead to muscle spasm, vasoconstriction, and other physiological changes. These changes have the potential to decrease pain tolerance, worsen the pain experience, and increase total suffering.7 Higher levels of pain are associated with decreased social activities, lower levels of social support, reduced social functioning, and lower resiliency of the social network.4 Patients with unrelieved cancer pain are at a high risk to consider and commit suicide.


Effective management of cancer pain begins with an assessment that determines the relationship between the pain and the disease, the types of mechanisms that might be sustaining the pain, and the extent to which the pain is accompanied by other symptoms or problems that might be addressed by an interdisciplinary pain team that complements expert pain management.8 The core elements of an initial assessment include a detailed history to determine the presence of persistent pain, breakthrough pain (ie, transitory flare-up of moderate to severe pain in patients with otherwise stable persistent pain), the impact of pain on functioning, a physical examination, a diagnostic evaluation for signs and symptoms associated with common cancer pain syndromes, and a psychosocial assessment.9

Only in the last decade has it become standard of care in large cancer centers to have mental health clinicians available to help patients manage the psychological symptoms that can increase and maintain their pain. A mental health clinician's background may be psychiatry, psychology, clinical social work, or ...

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