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Objectives Review the definition of pain and basic pathophysiology Review the common causes of pain in cancer patients Review approach to managing pain Defining Pain Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Taxonomy of Pain Classification may be based on: Anatomy Body System Temporal Characteristics Severity Etiology Pathophysiology Defined pain syndromes Taxonomy of Pain Clinically, it is useful to determine both the etiology and inferred pathophysiology in the assessment of the pain complaint, as this may suggest the use of specific therapies. Taxonomy of Pain Nociceptive Somatic Visceral Neuropathic Psychogenic Idiopathic Nociceptive Pain Nociceptive somatic pain Sustained predominantly by tissue injury or inflammation. Described as sharp, aching, stabbing, throbbing or pressure-like. Nociceptive visceral pain Poorly localized; described as crampy pain (e.g. obstruction of hollow viscus), or as aching and stabbing (e.g. pain secondary to splenomegaly). Neuropathic Pain Sustained by abnormal somatosensory processing in the PNS or CNS. Typically, described as “burning,” “shock-like,” “electrical.” May be paroxysmal in nature. On physical examination, patients may have allodynia (pain induced by non-painful stimuli) and hyperalgesia (increased perception of painful stimuli). Psychogenic Pain Refers to pain that is believed to be sustained predominantly by psychological factors. Rare in the cancer population. Idiopathic Pain In the absence of evidence sufficient to label pain as either nociceptive or neuropathic, we may use the term “idiopathic.” In patients with cancer, this term should lead to additional workup and a search for an underlying etiology and pathophysiology. Basic Pathophysiology of Pain Transduction Conversion of thermal, chemical, mechanical stimulus to electrical activity at nociceptor Na channels Conduc