From the Guidelines
Cancer-related pain can be effectively managed with a combination of pharmacologic and nonpharmacologic interventions, including opioids, nonopioid analgesics, adjuvant analgesics, and integrative medicine techniques.
Management Approach
The management of cancer-related pain involves a multimodal and comprehensive approach that includes routine pain assessments, pharmacologic and nonpharmacologic interventions, and ongoing reevaluation of the patient 1.
- Pharmacologic interventions may include nonopioid analgesics (such as acetaminophen or an NSAID), adjuvant analgesics (antidepressants, anticonvulsants, topical agents, and corticosteroids), and/or opioid analgesics 1.
- Opioids are the foundation of cancer pain management, particularly for moderate-to-severe pain, but their use is often limited by challenges such as reduced reimbursement, high patient copays, and a lack of availability at retail pharmacies 1.
- Integrative medicine techniques, such as those recommended by the Society for Integrative Oncology-ASCO guideline, can also be effective in managing cancer-related pain, particularly for patients experiencing chronic pain resulting from cancer treatment 1.
Key Considerations
- Pain prevalence is high in cancer patients, particularly in the advanced stage of disease, with estimates ranging from 33% in patients after curative treatment to 64% in patients with metastatic, advanced, or terminal disease 1.
- Undertreatment of cancer-related pain is common, with approximately one-third of patients not receiving appropriate analgesia proportional to their pain intensity 1.
- Effective pain management is critical throughout the cancer care trajectory, as chronic pain can negatively affect quality of life, daily functions, and adherence to oncologic treatment 1.
From the Research
Overview of Cancer-Related Pain Management
- Cancer-related pain is a significant issue, with 40% of patients experiencing poorly controlled pain 2
- Recent developments in oncology have led to improved pain control, with a focus on targeted treatments and personalized patient care 2
Current Concepts and Strategies
- The management of cancer-related pain has shifted towards an integrative and supportive approach, aiming to improve patient quality of life 2
- The WHO analgesic ladder has been updated, and a chronic cancer pain taxonomy has been included in the International Classification of Diseases (ICD-11) 2
- Opioids are still considered a mainstay of cancer pain management, but their use is being reassessed due to the opioids crisis 2, 3
Treatment Options
- Pharmacotherapy, including opioids, non-opioid, and adjuvant drugs, is a key component of cancer pain management 2, 3, 4
- Non-pharmacological strategies, such as nerve blocks, epidural analgesia, and local anesthetic infusions, are also effective 5, 6, 4
- Alternative therapies, including music therapy, acupuncture, and psychotherapy, may be beneficial for some patients 6, 4
Importance of Comprehensive Care
- Comprehensive cancer care should include safe, effective, and evidence-based management of cancer-related pain 5
- A thorough assessment of cancer-related pain is essential for optimal treatment 5
- Collaboration between patients, families, and healthcare professionals is crucial for improving cancer pain management 2, 4