<p>Cancer Pain Management: An Italian Delphi Survey from the Rational Use of Analgesics (RUA) Group</p>

Abstract

Background: In patients with cancer, the prevalence of pain is high, and pain management is often challenging despite the wide availability of drugs and guidelines. Methods: This Delphi survey was organized within the Rational Use of Analgesics (RUA) Group projects to reach a consensus among Italian palliative care specialists on pain assessment and management. Items were identified from recent publications on cancer pain and guidelines. Results: This survey included input from 190 palliative care specialists representing all Italian territory. A consensus was reached on 17 statements. Items concerning pain assessment achieved over 70% agreement amongst the participants. Items on principles of pain management and management according to type of pain, including breakthrough cancerrelated pain and neuropathic pain also achieved high levels of agreement. Conclusion: Results from the RUA project showed that Italian palliative care specialists had a particular interest in items related to pain challenges, in addition to the evaluation and control of pain associated with cancer. However, some discrepancies between current guidelines and clinical practice were observed.

Development of the Practice of Pharmaceutical Care for Cancer Pain Management in Outpatient Clinics Using the Delphi Method

“…Another study reached a consensus on pain assessment and management, but it did not consider the entire process of pharmaceutical care. Furthermore, it did not include the considerations of medical documents and evidence-based references ( Varrassi et al, 2020 ). However, this study paid attention to the process of pain assessment and management in the real outpatient environment, which may have more potential in developing the standardized pharmaceutical care for pain and enhancing the level of pain management.…”

Influence of Physical Activity on Pain, Depression and Quality of Life of Patients in Palliative Care: A Proof-of-Concept Study

“…Improvement of the quality of life of palliative patients is a huge challenge for health care professionals. Frequently, pharmacological treatment, even if prescribed on a rational basis, [ 14 ] is not enough. Physical and psychological indices are very important to manage pain [ 15 ], and when a peripheral neuropathy is present, non-pharmacological management may be helpful [ 16 ].…”

An Italian Expert Consensus on the Use of Opioids for the Management of Chronic Non-Oncological Pain in Clinical Practice: Focus on Buprenorphine.

“…A recently published Italian Delphi Survey on the rational use of analgesics in patients with cancer pain confirmed the consensus among pain specialists on the use of strong opioids, at low doses, to provide an adequate pain control in oncological patients with mild or moderate pain not controlled with NSAIDs. 30 CDC guidelines 31 and ASIPP recommendations 32 support the use of short acting lowpotency opioids such as tramadol and codeine (also associated with acetaminophen) for management of acute to moderate pain and for exacerbation of chronic pain. However, short acting formulations are associated with wider fluctuations of plasma concentrations, which may induce tolerance and addiction.…”