Pharmacologic Management of Cancer-Related Pain

Cancer-induced pain reflects a multiplicity of underlying mechanisms. It may arise from nociceptive damage, neuropathic damage, or both, and neuropathic pain may also be related to treatment. Initial and ongoing assessment of pain should be an integral part of supportive oncology. A variety of options are available for pain management, depending on the type and source of the pain. Opioids are the mainstay of management of moderate-to-severe cancer-induced pain. Interventional management of pain, which comprises a number of invasive analgesic therapies, may be used in selected patients. Buprenorphine, a biased opioid agonist, produces analgesia with fewer adverse effects. The use of pharmacogenomic testing for opioids remains controversial in cancer patients.