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Palliative cancer care - pain - Management
How should I assess the characteristics of the pain?
- Enquire about:
- Site and number of pains.
- Radiation.
- Quality.
- Timing (onset, duration, breakthrough or incident pain).
- Exacerbating and relieving factors.
- Associated symptoms and signs.
- The person's thoughts about the likely cause.
- Pain that presents insidiously and progressively worsens suggests a malignant cause for the pain.
- Acute onset of pain may be of a non-cancer related cause (for example, pulmonary embolism, myocardial infarction, perforation of a viscus). Cancer-related causes include pathological fracture, bleeding into hepatic metastases, or spinal cord compression.
- The quality of the pain and exacerbating features can also suggest a cause.
Table 1. Features suggesting a mechanism of the pain.
Character of the pain | Likely cause |
|---|
Burning, shooting, tingling, altered sensation (especially hypersensitivity and allodynia) | Nerve pain (due to nerve compression, for example) |
Headache associated with nausea, worse on lying down, especially in the mornings | Increased intracranial pressure |
Pain worse on weight bearing or stressing/pressure on the bone | Bone pain (due to metastasis or fracture, for example) |
Crampy, intermittent pain occurring regularly every few minutes | Intestinal colic (due to bowel obstruction, for example) |
Pain in a particular muscle, tenderness over trigger point(s) | Muscle spasm |
|
Basis for recommendation
- CKS found no trial evidence but have based this recommendation on expert opinion in a palliative care guideline [NHS Fife, 2006a] and a guide to symptom management in palliative care [Regnard and Hockley, 2004a].
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