Nursing Assessment of Cancer-Related Pain

Classifying pain in the cancer population involves distinguishing pain associated with the treatments, the tumor, or idiopathic pain, and between chronic and acute pain.

Because cancer pain is inherently subjective, obtaining a client self report of pain perception is essential for an accurate nursing assessment(5). Individualized pain therapy should take into account the stage of disease, concurrent medical conditions, characteristics of the pain, and the psychological and cultural status of the patient (6).

Careful evaluation of the client is necessary to identify the root cause of pain, to discover what exacerbates the client�s pain experience, and to select treatment modalities which address the underlying causes of cancer-related pain (7).

There is one caveat to mention concerning client assessment: the phenomenon of clients denying cancer pain to themselves and others, under the pretense that to admit to the pain may signify disease progression in the mind of the client (8). Another reason for denial of cancer-related pain; that some clients fear that reporting pain too often to members of the healthcare team will label the client a complainer, resulting in decreased attention and pain control(9)

In the current healthcare climate of cutbacks, increasingly high acuity clients, and a shortage of nurses, one can almost understand the client�s misguided rationale for not wanting to �bother� the nurse, and for remaining quiet in the face of pain.

Consequently, during assessment, nurses must be acutely aware of the subliminal, nonverbal signs of poorly controlled pain, especially in quiet clients.

Clients with cancer-related pain are experiencing not only physical discomfort, but may be bewildered by the diagnosis or prognosis of their disease. For many, this may the first time facing their own mortality; nurses must also be mindful of the alien environment of the hospital for the client, and that the unfamiliar diagnostics and procedures to be undergone may play a part in their silence.

Further, we must strive to create therapeutic relationships through which the client feels he or she can trust that the nurse is there as an advocate, and to provide comfort, empathy, support, and professional care. It is suggested that a more holistic approach to care may be warranted for promotion of adequate management of cancer-related pain.

(5)Woodgate, R.L. & Degner, L. F.(2003). Expectations and beliefs about children's cancer symptoms: Perspectives of children with cancer and their families. Oncology Nursing Forum, 30(3), 479-491.
Mazanec, P. & Bartel, J. (2002). Family caregiver perspectives of pain management. Cancer Practice, 10(S-1). S66-S69.
Lesage, P. & Portenoy, R.K.(1999). Cancer control. Journal of the Moffitt Cancer Center, 6(2), 136-145.
(6) Ripamonti, C. & Dickerson, E.D. (2001). Strategies for the treatment of cancer pain in the new millennium. Drugs, 61 (7).
(7) Zorn, M., Rowland, J.H. & Varricchio C.G.(2002). Symptom Management in cancer: Pain, depression, and fatigue. Bethesda, MD: National Library of Medicine
(8)(9)Ersek, M. (1999). Enhancing effective pain management by addressing patient barriers to anagesic use. Journal of Hospice and Palliative Nursing, 1(3), 87-96.
Otis-Green, S., Sherman, R., Perez, & Baird, Rev. P. (2002). Cancer Practice, 10(1), S58-S65