Intended for healthcare professionals

Practice Guidelines

Control of pain in adults with cancer: summary of SIGN guidelines

BMJ 2008; 337 doi: (Published 05 November 2008) Cite this as: BMJ 2008;337:a2154
  1. P J Cormie, general practitioner1,
  2. M Nairn, programme manager2,
  3. J Welsh, professor of palliative medicine34
  4. on behalf of the Guideline Development Group
  1. 1Stow Health Centre, Stow, Galashiels TD1 2SQ
  2. 2Scottish Intercollegiate Guidelines Network, Edinburgh EH7 5EA
  3. 3Division of Cancer Sciences, Faculty of Medicine University of Glasgow, Glasgow
  4. 4Beatson West of Scotland Cancer Centre, Glasgow G12 0YN
  1. Correspondence to: M Nairn moray.nairn{at}

    Why read this summary?

    About a third of patients with cancer report pain, rising to three quarters in the advanced stages of the disease.1 Cancer pain has many dimensions including psychological, physical, social, and spiritual, which must be addressed in order to improve quality of life and functional ability. Surveys show that the effectiveness of pain control in patients with cancer varies, with 12% to 51% of patients reporting unsatisfactory pain control.2 3 This article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the control of pain in adults with cancer.4


    SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (fig 1), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”) based on the clinical experience of the guideline development group is also indicated (as GPP).

    Fig 1 Explanation of SIGN grades of recommendations

    Factors affecting patients

    • Good communication between health professionals, patients, and carers is important for accurately assessing pain and improving compliance with treatment (GPP).

    • Cancer can destabilise patients’ lives in terms of their self identity, belief systems, and place in the world. Health professionals should have skills to help patients deal with this spiritual pain (GPP).

    Psychosocial factors

    Psychological factors can profoundly influence the perception of pain and how the patient responds behaviourally and emotionally. The meaning of pain for patients with cancer may differ from that for patients with non-life threatening illness. Some patients with cancer may see increased pain as a sign of disease progression or the failure of strong medication, and this may affect mood and adherence to treatment protocols.

    • In a comprehensive chronic pain assessment, include routine screening for psychological distress using a validated tool such as the brief …

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