To treat pain, it must be measured. The patient and the doctor should measure pain levels at regular intervals after starting cancer treatment, at each new report of pain, and after starting any type of treatment for pain. The cause of the pain must be identified and treated promptly.

Patient Self-Report

To help the health care provider determine the type and extent of the pain, cancer patients can describe the location and intensity of their pain, any aggravating or relieving factors, and their goals for pain control. The family/caregiver may be asked to report for a patient who has a communication problem involving speech, language, or a thinking impairment. The health care provider should help the patient describe the following:

• Pain: The patient describes the pain, when it started, how long it lasts, and whether it is worse during certain times of the day or night.

• Location: The patient shows exactly where the pain is on his or her body or on a drawing of a body and where the pain goes if it travels.

• Pattern: The patient describes if there have been changes in where the pain is, when the pain occurs, and how long it lasts, or if there is new pain.

• Intensity or severity: The patient keeps a diary of the degree or severity of pain.

• Aggravating and relieving factors: The patient identifies factors that increase or decrease the pain. The patient also identifies symptoms that are most troublesome, since they are not always the most serious or severe.

• Personal response to pain: Feelings of fear, confusion, or hopelessness about cancer, its prognosis, and the causes of pain can affect how a patient responds to and describes the pain. For example, a patient who thinks pain is caused by cancer spreading may report more severe pain or more disability from the pain.

• Behavioral response to pain: The health care provider and/or caregivers note behaviors that may suggest pain in patients who have communication problems.

• Goals for pain control: With the health care provider, the patient decides how much pain he or she can tolerate and how much improvement he or she may achieve. The patient uses a daily pain diary to increase awareness of pain, gain a sense of control of the pain, and receive guidance from health care providers on ways to manage the pain.