Pain and its management are important issues for patients with cancer. They are a vulnerable population, and their symptom management should be high on clinicians’ list of priorities. But tool development for measuring pain objectively and monitoring for complications needs improvement, and nursing can be at the forefront of this initiative.

More than 60% of patients with advanced stage disease or metastatic cancer will experience pain.1 Pain is one of the leading reasons patients seek medical treatment, and their pain may be undertreated.2,3 Furthermore, the Institute of Medicine has reported that pain costs approximately $560 billion to $635 billion annually.4

Pain management seeks to ease a patient’s suffering through a multitude of pharmaceutical and nonpharmaceutical interventions.5 Opioid analgesia is the primary pharmacologic intervention for managing pain, but opioid delivery relies on the patient’s report of pain via a tool.5

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There are various tools for assessing a patient’s pain, but the best tool is a patient’s self-report.5 However, self-report must be coupled with a tool for assessing complications to indicate the effectiveness of the pain management regimen.

Anticipating Complications

Pain management is a delicate dance between potential complications and effectiveness of the intervention. And nurses are essential in preventing adverse effects.

Potential side effects and complications from opioid use for pain management are dizziness, nausea, vomiting, constipation, physical dependence, tolerance, sedation, and respiratory depression.6 Patients should be educated about these potential complications, and they should be monitored closely, especially when there are route changes in medication. In fact, the Joint Commission considers the safe use of opioids in hospitals an important issue, publishing a Sentinel Alert in 2012.7

One of the most feared unintended complications when managing a patient’s pain is opioid-induced respiratory depression.5 In the clinical setting, this condition is described in terms of decreased respiratory rates (ie, <10 breaths/min). Although respiratory depression is uncommon, it is the most serious of complications and is associated with increased mortality.3 Therefore, monitoring for respiratory depression can be the first step in ensuring patient safety when opioids are delivered.