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ESMO E-Learning: Difficult Pain Problems


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Learning objectives

  • To understand the clinical implications of non-adequate pain relief with routine approaches.
  • To learn about different types of difficult pain problems in cancer patients, their clinical manifestations and the management issues from the aspect of pain mechanism.
  • To be familiar with pain assessment, physiology and a range of therapeutic strategies.

After two years E-Learning modules are no longer considered current. There is therefore no CME test associated with this E-Learning module.


Clinicians treating patients with cancer should recognise the common cancer pain syndromes. Prompt diagnosis and treatment of these syndromes can reduce morbidity associated with unrelieved pain. 10-30% of cancer patients do not achieve adequate relief with routine approaches. Several syndromes are widely recognised as being more resistant to conventional strategies and their management is challenging.

Difficult cancer pain syndromes may arise from interruption of bone, viscera, and neural structures by malignant spread of the disease. The fluctuating nature of cancer pain intensity is a relevant clinical feature and depends on disease patterns and pain mechanisms. This module reviews the ways of classifying difficult pain problems in the cancer population. By focusing on the care of the cancer patient with pain, it is imperative to understand the aetiology and physiology of pain in relation to the cancer, and to be familiar with pain assessment, and a range of therapeutic strategies. This module is an excellent introduction to the next module which deals with stepwise approach to the management of difficult pain problems.

This E-Learning module was published in 2010 and expired in 2012.

Declaration of interest

The author receives an unrestricted educational grant from Perdue Pharma

Last update: 22 Sep 2010

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