13. Pain

Pain is common in oral cancer and, though not always present, can be an early symptom at presentation, in patients on treatment, and post-treatment. However, little has been published on its management.

Pain is defined as ‘an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. An individual's perception of pain is complex and involves not only pain (nociceptive) and non-nociceptive nerve impulses, but also psychological and emotional processes. It can also vary between cultures, and with tiredness and fatigue. The intensity of pain experienced is thus not always proportional to the type or extent of tissue damage.

Cancer pain may arise from tumour invasion (especially where nerves are infiltrated), ulceration and infection, and the effects of diagnostic or therapeutic procedures (surgery, RT or CTX). Cancer pain can be controlled in approximately 90% of patients, but undertreatment is common, because of factors such as negative attitudes towards the use of narcotic drugs for pain relief, and clinicians' understanding of effective analgesia.