Basic Principles of Cancer Pain Management

The World Health Organization developed a 3-step approach for pain management based on the severity of the pain:

• For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID). Patients should be monitored for side effects, especially those caused by NSAIDs, such as kidney, heart and blood vessel, or stomach and intestinal problems.

• When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancer -related pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain.

• At each step, the doctor may prescribe additional drugs or treatments (for example, radiation therapy).

• The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).

• The doctor may prescribe additional doses of drug that can be taken as needed for pain that occurs between scheduled doses of drug.

• The doctor will adjust the pain medication regimen for each patient's individual circumstances and physical condition.