Assessing cancer pain

This information is sourced from NICE, Macmillan and Marie Curie

Pain can be complex to assess and influenced by multiple factors in palliative illness. Total pain includes physical, emotional and spiritual pain and is strongly influenced by practical issues and worries about the future. This is a pragmatic summary for assessing a patient in the community. Please see the references below for further reading.

Red flags

These depend on the cause. But remember to consider bowel obstruction in patients with abdominal pain or spinal cord compression in neuropathic pain.

Key clinical features to assess
  • Review underlying diagnosis (e.g. site of known tumours) and prexisting co-morbidities - ischaemic heart disease, osteoarthritis e.t.c.
  • Medication review. What analgesics are they currently taking? Are the medicines giving 24 hour pain relief and what helps most? 
  • Examination of the painful area to try and elucidate the cause. Remember referred pain. Remember shingles which is common in people with advanced disease and on steroids
  • Assessment of mood and other key concerns
An initial approach to treatment
  • Treat according to likely cause (see table)
  • If cause of pain unknown follow the WHO ladder
  • Remember antiemetics and laxatives
  • Review response to initial treatment

Common causes of pain and initial treatments: 

Type of pain Possible cause  An initial approach to treatment
Burning, shooting, tingling, altered sensation, dermatomal distribution Nerve pain (due to nerve compression, for example) See Neuropathic pain
Headache associated with nausea, worse on lying down, especially in the mornings Increased intracranial pressure from brain metastases Start on 6-8mgs dexamethasone and discuss with oncologist
Pain worse on weight bearing or tender areas of bone Bone pain (due to metastasis or fracture, for example) See Bone pain 

Abdominal pain

 

Constipation

Dyspepsia

Liver metastases Peritoneal metastases (e.g bowel or gynaecological)

Bowel obstruction

Renal colic

Biliary colic

 See Abdominal pain 
Chest pain

Rib or pleural metastases 

Consider pre-existing cardiac and respiratory causes

 See Bone pain 

Sources

NICE CKS Palliative care - pain

Published 1st March 2021

Marie Curie - Pain in terminal illness

Published 11th May 2021

Macmillan - Managing cancer pain

Published 1st August 2022

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