Management of cancer pain: basic principles and neuropathic cancer pain

Pain is one of the commonest symptoms in patients with cancer occurring in as many as 90% of patients during their illness. Pain is a complex phenomenon, which can be exacerbated by numerous other factors. This paper discusses the common strategies for the management of cancer pain in general and also neuropathic cancer pain. Using the World Health Organisation (WHO) analgesic ladder for cancer pain relief, 80% of cancer pain can usually be controlled. It follows therefore that 20% of cancer pain can be difficult to control. Neuropathic cancer pain is often in this category and the use of adjuvant analgesics such as amitriptyline and gabapentin is important. Optimum cancer pain control is achieved by integrating standard analgesic approaches during tumouricidal therapy or any other active cancer treatment.