SIAARTI recommendations on the assessment and treatment of chronic cancer pain F. AMBROSIO, F. PAOLETTI, G. SAVOIA, B. AMANTEA, E. ARCURI, F. AVOGARO, A. BARBATI, D. BELTRUTTI, L. BRANCA, D. CAMAIONI, F. DE CONNO, A. DE LUCA, A. DI MASSA, M. EVANGELISTA, G. FINCO, S. ISCHIA, C. MATTIA, A. MASCARO, S. MERCADANTE, G. ORLANDINI, R. PALOMBA, A. PASETTO, E. POLATI, W. RAFFAELLI, G. VARRASSI, M. VISENTIN, E. ZUCCO Generalities Epidemiology W orldwide, an estimated 9 million new cases of cancer occur each year, over half of them in developing countries. Within the European community, 1 the annual figure is calculated at 1 292 00 for all forms of can- cer (1990). The incidence rates in the 13 are- as reporting to Italian the National Tumor Registries are estimated at 250 000 new cas- es annually. The annual death toll from can- cer numbers 150 000, making it the 2 nd high- est cause of death in Italy. 2 Five-year-survival rates have increased, accounting for 40% of all malignant tumors. Most of these patients are incurable at diagnosis. The clinical presentation that most seri- ously complicates the course of the disease is the pain syndrome. Despite numerous pub- lications on the vast array of therapeutic strat- egies and the extent of the problem, epidem- iological studies have yet to define general incidence rates or specific phases of the ill- ness and conditions of care provided. All authors emphasize, as do the official reports published by the World Health Organization (WHO), 2 that pain is present in 30-40% of patients in the initial phases of the disease and in 60-80% of those in the so- called terminal phase. 3, 4 Studies carried out in English-speaking countries 5, 6 have estimat- ed that the incidence of terminal phase illness accounts for approximately 90% of cancer patients and that this phase has an average duration of about 90 days. These data give some idea of how greatly pain affects cancer patients every day and of the many prob- lems related to adequate pain management. Pain remains the most serious problem in 75% of patients on admission to a health care setting. 6 According to ISTAT data, in Italy an estimat- ed 85% of annual admissions during the advanced stage of the disease is done only to provide support care or pain management. 7 . Geriatric population A large-scale study conducted on patients with advanced disease reported that the prev- alence of severe pain and the use of opiod analgesic agents diminished with patient age. 5, 6 Age-correlated reduction in opiate pain control was also reported in a study conducted at a general hospital and in the National Hospice Study. 8 However, the pros- pect of lower incidence of severe pain in older people does not limit the portent of the problem, since the lower incidence is off- set by the exacerbation of the psychodynam- ic-social discomfort that the pain, although not severe, causes in the geriatric patient. Despite the lack of pertinent data, some authors have reported a prevalence of pain in the population over 60 years of age double that of those under 60. The routine restriction Vol. 69, N. 9 MINERVA ANESTESIOLOGICA 697 LINEE GUIDA SIAARTI MINERVA ANESTESIOL 2003;69:697-729