High-quality management of
cancer pain depends on evidence-based standards for screening, assessment, treatment, and follow-up for general
cancer pain and specific
pain syndromes. We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Providers should routinely screen for the presence or absence and intensity of
pain and should perform descriptive
pain assessment for patients with a positive screen, including assessment for likely etiology and functional impairment. For treatment, providers should provide
pain education, offer breakthrough
opioids in patients receiving long-acting formulations, offer bowel regimens in patients receiving
opioids chronically, and ensure continuity of
opioid doses across health care settings. Providers should also follow up on patients
after treatment for
pain. For metastatic bone
pain, providers should offer single-fraction
radiotherapy as an option when offering radiation, unless there is a
contraindication. When
spinal cord compression is suspected, providers should treat with
corticosteroids and evaluate with whole-spine magnetic resonance imaging scan or myelography as soon as possible but within 24 hours. Providers should initiate definitive treatment (
radiotherapy or
surgical decompression) within 24 hours for diagnosed cord compression and should follow up on patients
after treatment. These standards provide an initial framework for high-quality evidence-based management of general
cancer pain and
pain syndromes.