Pain is common in cancer patients. Over two-thirds of patients would have pain at some stage of cancer. Advanced cancer patients would manifest various components of pain. Pain is explained in terms of not just physical pain but also associated with other components like psychological, social, and spiritual. ‘Total Pain’ management remains the utmost priority of cancer patient management. It requires multidimensional and multimodal management. A multidisciplinary approach would provide a better outcome for cancer patients with pain with improved quality of life (QoL). A systematic approach to the assessment of the person as a whole including all dimensions of pain is the key to providing a satisfactory management plan leading to patient satisfaction.
Drug management has been well described in the literature and used effectively for pain management. World Health Organization (WHO) analgesic ladder remains the main guidance for the selection of the drug. It has been modified further with the integration of other therapies like pain interventional procedures, and other supportive therapy. These have been found to improve patient satisfaction with regard to pain relief and decrease the side effects of the drugs as well. Non-drug interventions are necessitated to relieve the psychological or spiritual distress of advanced cancer patients. With regards to drug therapy, conventional analgesics like non-steroidal anti-inflammatory drugs (NSAIDs) and opioids remain the mainstay. The adjuvants have also an important role and thus appropriate prescription needs to have a combination of drugs. This requires a holistic assessment of the patients to understand the need for different drugs and other non-drug interventions.
Patient and family members’ involvement in overall patient management provides a better outcome with regard to satisfaction of all. The aim of such integration is to provide an improved quality of life till the end. Advanced cancer patients may also have associated other symptoms like dyspnoea, ascites, pleural effusion, and spinal cord compression in addition to pain. These symptoms need appropriate management as they lead to poor quality of life. Hence holistic management should comprise all symptom management. Nutritional issues also occur due to poor intake or assimilation because of underlying diseases or side effects of therapy like chemotherapy or radiation therapy.
All these interventions need to be continued optimally till the end. Effective home support would be more appropriate for advanced cancer patients especially when the terminal illness occurs. Patient and family support is essential in this phase s as well. The literature has reported the role of the above-mentioned concepts. However, concrete evidence is yet to be generated. This special edition of the journal would invite the manuscript related to holistic cancer pain management. The journal invites original articles for this special edition.