"Several studies show that more than 50% of cancer patients report pain on a daily basis, with about one-third of those reporting moderate to severe pain," says Richard Payne, MD, Chief of Pain and Palliative Care Services at Memorial Sloan-Kettering Cancer Center in New York, one of the 18 member institutions of the NCCN. "These guidelines can help patients ensure they get the relief from pain that they need."

"Many of the strategies required to effectively manage cancer pain are quite complex and unique," says Robert C. Young, MD, President of Fox Chase Cancer Center in Philadelphia, and president-elect of the American Cancer Society.

"For example, a cancer patient may need medication for pain before admission to the hospital for surgery to remove a cancer, then need higher doses for acute pain following surgery, then need other options when she is again an outpatient, when residual pain must be managed but the hospital medications are not available," says Young.

"Or, a mass may be impinging on a nerve, requiring special kinds of medications and techniques. Or perhaps she is intolerant of one pain medication, or it's not working -- there are many unique and difficult situations and many doctors are not completely familiar with all the strategies and tools for managing them," adds Young.

Young says the guidelines were originally developed by the NCCN for doctors, to help them better understand the wide range of options available to control cancer pain. The ACS translated them into plain language so that patients could communicate more effectively with their doctors to get the pain relief they need.

The guidelines cover:

• The causes of cancer pain
• How to assess pain
• The range of medicines available to treat pain
• Obstacles to pain relief and how to overcome them
• The support needed from friends and family
• Other topics related to cancer pain and a dictionary of terms

The guidelines do not cover specific drugs and dosages, generally unique for each patient, but instead describe the strategies best used to control pain in various situations.

Young says it's important for patients not to let unrealistic fears of addiction to cancer pain drugs (such as codeine, an opioid) stand between them and the pain relief they need.

"Addiction is essentially not a problem in cancer patients; it is extraordinarily rare that cancer patients will become addicted to [opioids] even if they're used extensively," he says. "One study showed that of over 11,000 patients treated for pain relief, only 4 patients turned out to have an addictive pattern in their histories; the second study showed that in 550 patients treated more than 40 days with [opioids] for pain management, there was not a single addiction among them; in practical terms, it's simply not a problem," notes Young.

"Virtually all patients with cancer pain can be effectively treated," says Young. "Sometimes it is an easy problem to solve, sometimes it's more complex, but patients with cancer should go into their treatment with the expectation that their pain can and will be managed over the course of their illness."

"If necessary, the patient should simply say, "I know it's possible to control my pain and I will require referral to physicians in settings where that pain can be relieved," says Young. "These guidelines will help patients understand what the options are and how to get what they need and deserve," he adds, "and we're very pleased to help make them available to cancer patients.

The NCCN Cancer Pain Treatment Guidelines, Patients Version, can be obtained by calling the ACS toll-free at 1-800-ACS-2345 (1-800-227-2345) or by calling the NCCN at 1-888-909-NCCN, or by visiting the NCCN web site at http://www.nccn.org. The guidelines also can be requested by emailing to patientinformation@nccn.org. Other guidelines written especially for patients by ACS and NCCN covering the recommended treatments of breast, prostate and colorectal cancers, all based on expert evaluation of scientific and clinical evidence, are available through the same avenues.