Pain Assessment

  • The assessment of pain is part of the holistic care of the patient
  • 30% of people with cancer have no pain and those with pain often have several types.
  • Cancer pain may also be related to debility e.g. pressure ulcers.
  • A patient who feels cared for may feel less pain and a patient free from pain is better placed to face his/her illness. 95% of pain in cancer can be well controlled.
  • Patient and carer understanding of the use of their medication is vitally important in achieving good pain control.

Four types of cancer related pain

Visceral/soft tissue pain
– Opioid sensitive – use the “ladder” see Section: Analgesic Medication

Bone pain
– Maybe NSAID sensitive.
– Partly opioid sensitive.
– Radiotherapy may help.

Nerve related
– Partly opioid sensitive.
– Adjuvant analgesics may often be needed.

Incident pain
This is a specific type of breakthrough pain related to a particular activity, e.g. micturition, wound dressing changes or movement.

Other considerations

Many pains are not cancer related but may be:
– Treatment related e.g. constipation, post radiotherapy.
– Coincident illness or condition e.g. arthritis, migraine.

Many factors influence the perception of pain. e.g. fear, loneliness, boredom.

If the patient’s pain appears not to respond, consider alternative causes of pain (spiritual, social or psychological factors).


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.