At the time of diagnosis, 20%–75% of patients with cancer report having pain. Pain can be categorized as acute, chronic, breakthrough, or refractory and is caused by injury to body tissues (nociceptive) or damage to the peripheral or central nervous system (neuropathic).
Pain may be caused by the cancer, diagnostic procedures, cancer treatment, or pre-existing conditions. Neuropathic pain is associated with surgical procedures, such as radical neck dissection, mastectomy, thoracotomy, nephrectomy, and limb amputation, and with chemotherapy, including vinca alkaloids, taxanes, platinum compounds, and thalidomide (see the peripheral neuropathy PEP resources).
Research regarding the use of common opioid preparations for pain is not included in this evidence, because opioids are clearly known to be effective and meet criteria of Recommended for Practice because of effectiveness. Only new formulations or delivery methods are included for evidence categorization.
Click here for instructions on navigating the ONS PEP webpages. This topic was updated on November 9, 2015.
Acute pain is typically related to diagnostic procedures and cancer treatment and is generally defined as lasting no longer than three months. The most common types of acute pain related to cancer treatment are postoperative pain and the pain of oral mucositis. The acute pain of some patients with cancer may be caused by arthralgia or myalgia, which can be side effects of some chemotherapy drugs and biologic therapy.
Breakthrough pain is sudden, brief pain that occurs during a period when chronic pain is generally well controlled (typically, controlled with opiods). Breakthrough pain may happen when the patient is at rest or be related to activity or a change of position.
Chronic pain persists three months or more. The most frequent cause of cancer-related chronic pain is bone metastasis. Chronic pain may also be a result of cancer treatment, including surgery, chemotherapy, and radiation therapy.