Cancer is present in 160/100,000 males and 186/100,000 females worldwide, with some variability in frequency between countries.[1] The majority of these individuals (60%) experience pain, and 25% to 30% will have severe pain.[2,3] Those with common malignancies (eg, pancreatic or lung cancer) are likely to have pain at presentation to an oncologist or with their initial diagnosis. It is also likely that with certain cancers, opioids will be needed before chemotherapy treatment is started and that opioids will be more frequently prescribed than chemotherapy.
Several myths surround the use of opioids (Table 1).[4] These either hinder optimal opioid dosing or lead to miscommunication between clinician and patient. Analgesic prescribing errors are common among clinicians, despite the wide acceptance of the World Health Organization (WHO) "three-step ladder" guidelines. In our experience, > 50% of patients will have received opioid therapy with dosing errors when first referred to palliative services. Common errors are outlined in Table 2.[5]
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
