From the Guidelines
NCA in pain management refers to Neuropathic Cancer pain Assessment or more commonly, Nurse-Controlled Analgesia, but in the context of the provided evidence, it seems to be more related to the management of neuropathic pain rather than a specific acronym. However, based on the provided evidence, the management of neuropathic pain is a complex process that involves a step-wise approach.
Steps for Managing Neuropathic Pain
- Assess pain and establish the diagnosis of neuropathic pain (NP); if uncertain about the diagnosis, refer to a pain specialist or neurologist 1.
- Initiate therapy for the disease causing NP, if applicable, and initiate symptom treatment with one or more of the following: a secondary-amine tricyclic antidepressant (TCA) or an selective serotonin norepinephrine reuptake inhibitor (SSNRI), a calcium channel α-δ ligand, or topical lidocaine for localized peripheral NP 1.
- Reassess pain and health-related quality of life frequently, and adjust treatment accordingly, which may include adding another first-line medication or switching to an alternative first-line medication if there is no or inadequate pain relief 1. Some key points to consider in the management of neuropathic pain include:
- The use of TCAs, such as nortriptyline or desipramine, which have been shown to be effective in the treatment of NP, but may have cardiac toxicity as a concern 1.
- The use of SSNRIs, such as duloxetine or venlafaxine, which have also been shown to be effective in the treatment of NP, and have a simpler dosing regimen compared to TCAs 1.
- The use of calcium channel α-δ ligands, such as gabapentin or pregabalin, which have been shown to be effective in the treatment of NP, and have a relatively favorable side effect profile 1. It's worth noting that the management of cancer pain is a complex process that involves a multidisciplinary approach, including the use of pharmacological and non-pharmacological interventions, as well as behavioral and complementary therapies 1.
Key Considerations
- The importance of assessing pain and health-related quality of life frequently, and adjusting treatment accordingly.
- The need for a multidisciplinary approach to managing cancer pain, including the use of pharmacological and non-pharmacological interventions, as well as behavioral and complementary therapies.
- The importance of considering the potential side effects and interactions of different medications, and adjusting treatment accordingly.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition of NCA in Pain Management
- NCA stands for Nonpharmacologic Conservative Management or Nonpharmacological Conservative Approaches in pain management, however the exact definition of NCA is not explicitly stated in the provided studies.
Nonpharmacologic Therapies for Pain Management
- Nonpharmacologic therapies such as acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies are effective in managing postsurgical pain, acute non-surgical pain, cancer pain, and chronic pain 2.
- These therapies have the advantage of reduced risks of adverse events and addiction liability compared to pharmacologic treatments.
Evidence-Based Pain Management
- The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain 2.
- A tailored approach, support for self-management, and review of treatment outcomes are essential for optimal pain management 3.
Limitations of Current Evidence
- There is limited data on the efficacy of paracetamol in many pain conditions, and ibuprofen is usually superior to paracetamol at conventional doses in a range of painful conditions 4.
- Further research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies, and transcutaneous electrical nerve stimulation in pain management 3.