RELIEF of pain is the salient and most overriding responsibility of the physician caring for the patient with incurable cancer. Although inevitability of death can be emotionally accepted by most patients and their families, they will not accept the prospect of death in pain, nor should they. The single most reassuring action of the physician as he assumes the care of a patient with advanced cancer is the promise that the patient will not be allowed to suffer unbearable pain. This is a promise that can be kept through the skillful and knowledgeable use of tools readily available to us.
Before selecting nonspecific pain management, other therapeutic alternatives should be weighed. These could include palliative resection of primary or metastatic neoplasm when pain-producing lesions are amenable to surgical removal or bypass and when the anticipated longevity of the patient indicates that a reasonable period of palliation can be anticipated. Radiation