Control of pain in adults with cancer: summary of SIGN guidelines

Abstract

About a third of patients with cancer report pain, rising to three quarters in the advanced stages of the disease.1 Cancer pain has many dimensions including psychological, physical, social, and spiritual, which must be addressed in order to improve quality of life and functional ability. Surveys show that the effectiveness of pain control in patients with cancer varies, with 12% to 51% of patients reporting unsatisfactory pain control.2 3 This article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the control of pain in adults with cancer.4 SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (fig 1⇓), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”) based on the clinical experience of the guideline development group is also indicated (as GPP). Fig 1 Explanation of SIGN grades of recommendations ### Factors affecting patients ### Psychosocial factors Psychological factors can profoundly influence the perception of pain and how the patient responds behaviourally and emotionally. The meaning of pain for patients with cancer may differ from that for patients with non-life threatening illness. Some patients with cancer may see increased pain as a sign of disease progression or the failure of strong medication, and this may affect mood and adherence to treatment protocols.