(1)
Department of Anaesthesia, Royal Free Hospital, London, UK
Pain in cancer can be assessed only clinically. It is not a well-defined identity. It may be due to tumour, treatment related to tumour or completely unrelated to tumour. Optimum analgesia can be achieved in 80–90 % of patients with cancer pain. Eighty to ninety percent of pain is present during advanced stages of cancer. Pain may be lower in intensity in elderly people with advanced disease.
Pain seen in cancer patients is usually due to a mix of tumour presence, metastasis, cancer treatment, infections or unrelated pain. Pain may be nociceptive, neuropathic or mixed. Nociceptive pain is usually due to infiltration of tissue by tumour or metastasis and usually seen in superficial structures or osteo-articular system.
39.1 Nociceptive Somatic Pain
This is due to neoplastic infiltration of the tissues, thus activating peripheral nociceptors. This may be associated with treatment pain or surgical incision pain. The mediators involved are substance P, bradykinin and serotonin. Nerve growth factor can facilitate tumour invasion and contribute to pain. TNFα is associated with hyperalgesia. The tumour may cause direct proteolysis as is seen in osteosarcoma.
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