Adult Cancer Pain: Part 1 -- The Latest Guidelines for Assessment

Laura A. Stokowski, RN, MS


December 01, 2010

In This Article

Editor's note:

This is the first of a 2-part series describing the changes to the National Comprehensive Cancer Network's (NCCN) as found in the updated 2010 guidelines on the management of adult cancer pain. Part 1 covers Assessment of Pain in Patients With Cancer, and Part 2 covers Management of Pain in Patients With Cancer.

It is not death or pain that is to be dreaded, but the fear of pain or death.
(Epictetus, AD 55-135)


For some people diagnosed with cancer, the fear of pain is greater than the fear of death. I don't know if this is really true, but the prospect and dread of pain surely add to the panoply of emotions experienced by the patient with newly diagnosed cancer. Pain, in spite of being a markedly subjective experience, is a common and inevitable feature of many cancers.

We have learned much about pain in the past few decades. We have more pain-relief options than ever before, and roadmaps in the form of evidence-based guidelines to help us use them appropriately. It is puzzling, then, that cancer pain continues to be undertreated or poorly treated in so many patients.[1] These variances imply that cancer pain treatment isn't simple or straightforward, and many factors (opinions, beliefs, culture, and even genetics) influence cancer pain management.

The NCCN Guidelines for Adult Cancer Pain, Version 2010

The National Comprehensive Cancer Network (NCCN) recently updated its Adult Cancer Pain guidelines.[2] NCCN guidelines combine evidence and expert medical judgment and have a multidisciplinary focus. These guidelines are intended to provide practical, usable assistance to clinicians who are assessing and managing cancer pain. The guidelines are not text-heavy, but are organized in quick-reference algorithm format.

Some of the changes to the new guidelines, abbreviated here as NCCN v.2010, are minor, but others are significant, and all are important for pain and oncology professionals. I recently had the opportunity to review the changes to NCCN v. 2010 with one of the panel of experts ("the panel") who authored the guidelines and its revisions, Judith Paice, PhD, RN, Director of the Cancer Pain Program at Northwestern University; Feinberg School of Medicine in Chicago, Illinois.


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