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Chronic pain is a major factor that impairs functionality and compromises quality of life. Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management. Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain. Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient. This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Sodium channels play a pivotal role in maintaining homeostasis and proper intracellular ion concentrations that are vital to all living cells for function and survival. In excitable tissues such as neurons and heart cells, sodium channels are responsible for establishing and maintaining the transmembrane electrochemical gradient, which is critical for intercellular communication and for the transduction, generation, modulation, and transmission of impulses that underlie normal physiologic function, the perception of stimuli, and the execution of appropriate behavioral responses. Injury and disease often affect changes in the channel density and subtype distribution present in cellular membranes, thereby upsetting the critical electrochemical balance necessary for normal functioning. When such changes affect the systems that process noxious stimulation and are acute and transient, they are beneficial. The pain that is perceived alerts us to current or impending injury and aids in vigilance during wound healing. But when the changes are persistent, the painful signals are no longer protective but, instead, become unrelenting and destructive to the quality of life. Because changes in sodium channel quantity and distribution play such a central role in the perception of pain and the development and maintenance of nociceptive chronicity, significant effort has been expended on discovering ways to affect sodium channel expression and function that might be effective in preventing or managing many painful conditions. The implications of modifying sodium channel expression and function for future therapeutic benefit are the subject of this review. Key Words: Acute pain, chronic pain, sodium channels