Pain is a common symptom experienced by patients with cancer, from diagnosis through survivorship, and is characterized as being acute, chronic, breakthrough, and refractory/intractable. Whether as a result of disease or disease-related treatment, 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 (National Comprehensive Cancer Network, 2019; Paice et al., 2016). 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 must include screening for pain at each encounter, ongoing assessment, planning, intervention, and evaluation of pain and pain relief.
- Comprehensive pain management addresses physical, psychological, spiritual, and sociocultural effects of unrelieved pain and includes the use of pharmacologic and nonpharmacologic treatment for pain.
- Comprehensive cancer pain management includes educating the patient and family/caregivers in pain assessment and management, including the risks and benefits of long-term opioid therapy and the safe storage, use, and disposal of controlled substances.
- 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 (for example, young children, patients with learning disabilities, or those who are cognitively impaired) require special considerations for assessment of pain.
- 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 must establish mechanisms for continuous evaluation of pain outcomes in patients at risk for cancer pain.
- Regulatory, legislative, economic, and other barriers to effective cancer pain management must be eliminated.
- All professionals caring for patients with cancer have an ethical responsibility to acquire and use current knowledge and skills 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.
Download this position statement.
National Comprehensive Cancer Network. (2019). NCCN Clinical Practice Guidelines: Adult cancer pain [v.1.2019]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/pain.pdf.
Paice, J.A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., . . . Bruera, E. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34, 3325-3345.