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This Clinical Practice Guideline from the U.S. Department of Health and Human Services is no longer viewed as guidance for current medical practice, and are provided for archival purposes only.
Before accessing an electronic version of an outdated Clinical Practice Guideline, please be advised of the following:
- HSS makes no warranties regarding errors or omissions and assumes no responsibility or liability for loss or damage resulting from the use of information contained within.
- HSS cannot endorse, or appear to endorse, derivative or excerpted materials, and it cannot be held liable for the content or use of adapted products.
- It is the responsibility of the user to read and comply with the Electronic User Policy and Copyright Information for Clinical Practice Guidelines and to obtain permissions for use of any copyrighted materials contained within from copyright holders. Citation as to source is also required.
This guideline was developed by an interdisciplinary panel of clinicians, patients, researchers, and experts in health policy. The guideline provides a synthesis of scientific research and expert judgment to make recommendations on pain assessment and management. Approximately 470 health care professionals and 70 patients were involved either as consultants and peer reviewers or as participants in pilot testing.
The Clinical Practice Guideline for the Management of Cancer Pain was commissioned by the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR). It follows and makes reference to an earlier guideline on acute pain management after surgery or trauma, also commissioned by AHRQ. The cancer pain guideline includes a section on the management of HIV positive/AIDS-related pain because of similarities in the sources of pain and the management approaches. This guideline is designed to help clinicians understand the assessment and treatment of cancer pain and associated symptoms. It reflects a multimodal approach to the management of pain, and it emphasizes the need for careful and continuous assessment to match interventions to the sources of pain in individual patients.
This guideline is designed to help any clinician who works with any oncology patient in any setting to understand the assessment and treatment of pain and associated symptoms. The guideline was developed by an interdisciplinary panel of clinicians, patients, and experts in health policy. The panel used a combination of scientific evidence and expert judgment to make recommendations about pain management in patients with cancer. The guideline makes recommendations about the assessment and management of pain. Interventions described include the use of
(1) analgesics and adjuvant drugs;
(2) cognitive/behavior strategies;
(3) physical modalities;
(4) palliative radiation and antineoplastic therapies;
(5) nerve blocks; and
(6) palliative and ablative surgery.
The cost of cancer pain in suffering, disability, and quality of life is high. The guidelines recommend that cancer pain be treated aggressively by pharmacologic and nonpharmacologic approaches. In most instances, pain can be treated effectively with relatively low-cost, noninvasive therapies. Given this evidence, health system barriers that interfere with effective pain management – such as restrictive legislation regarding the uses of opioid analgesics and third-party payer practices that do not reimburse for less invasive interventions – should be changed.
This document is in the public domain and may be used and reprinted without special permission, except for those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. AHRQ appreciates citation as to source, and the suggested format is provided below:
Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No. 9. AHCPR Publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994. The electronic text of the entire guideline may be found online.
Last Published: 4/14/2008 Print this page
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