Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline

Paice, Judith A.; Portenoy, Russell K.; Lacchetti, Christina; Campbell, Toby C.; Cheville, Andrea L.; Citron, Marc L.; Constine, Louis S.; Cooper, Andrea; Glare, Paul; Keefe, F; Koyyalagunta, Lakshmi; Lévy, Michaël; Miaskowski, Christine; Otis‐Green, Shirley; Sloan, Paul A.; Bruera, Éduardo

doi:10.1200/jco.2016.68.5206

Cited by 429 publications

(344 citation statements)

References 96 publications

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“…It allows us to understand how the genetic variations could be used to tailor pain management therapies while improving the QOL of cancer patients. Recent guidelines highlighted the importance of assessing the risk of adverse effects of opioids used in pain treatment and outlined the precautions that help ensure that cancer patients with persistent pain use opioids safely and effectively [26]. …”

Section: Discussionmentioning

confidence: 99%

OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings

Hajj

Halepian

Osta

et al. 2017

IJMS

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Despite increased attention on assessment and management, pain remains the most persistent symptom in patients with cancer, in particular in end-of-life settings, with detrimental impact on their quality-of-life (QOL). We conducted this study to evaluate the added value of determining some genetic and non-genetic factors to optimize cancer pain treatment. Eighty-nine patients were included in the study for the evaluation of palliative cancer pain management. The regression analysis showed that age, OPRM1 single nucleotide polymorphism (SNP), as well as the duration of morphine treatment were significantly associated with morphine doses at 24 h (given by infusion pump; p = 0.043, 0.029, and <0.001, respectively). The mean doses of morphine decreased with age but increased with the duration of morphine treatment. In addition, patients with AG genotype c.118A>G OPRM1 needed a higher dose of morphine than AA patients. Moreover, metastases, OPRM1 SNP, age, and gender were significantly associated with the QOL in our population. In particular, AA patients for OPRM1 SNP had significantly lower cognitive function than AG patients, a result not previously reported in the literature. These findings could help increase the effectiveness of morphine treatment and enhance the QOL of patients in regards to personalized medicine.

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Section: Discussionmentioning

confidence: 99%

OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings

Hajj

Halepian

Osta

et al. 2017

IJMS

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“…These recommendations are separate and distinct from the ASCO practice guidelines for the management of chronic pain in survivors of adult cancers. 207 …”

Section: Strategies To Minimize Cipnmentioning

confidence: 99%

Ion channels and neuronal hyperexcitability in chemotherapy-induced peripheral neuropathy

Aromolaran

Goldstein

2017

Mol Pain

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Cancer is the second leading cause of death worldwide and is a major global health burden. Significant improvements in survival have been achieved, due in part to advances in adjuvant antineoplastic chemotherapy. The most commonly used antineoplastics belong to the taxane, platinum, and vinca alkaloid families. While beneficial, these agents are frequently accompanied by severe side effects, including chemotherapy-induced peripheral neuropathy (CPIN). While CPIN affects both motor and sensory systems, the majority of symptoms are sensory, with pain, tingling, and numbness being the predominant complaints. CPIN not only decreases the quality of life of cancer survivors but also can lead to discontinuation of treatment, thereby adversely affecting survival. Consequently, minimizing the incidence or severity of CPIN is highly desirable, but strategies to prevent and/or treat CIPN have proven elusive. One difficulty in achieving this goal arises from the fact that the molecular and cellular mechanisms that produce CPIN are not fully known; however, one common mechanism appears to be changes in ion channel expression in primary afferent sensory neurons. The processes that underlie chemotherapy-induced changes in ion channel expression and function are poorly understood. Not all antineoplastic agents directly affect ion channel function, suggesting additional pathways may contribute to the development of CPIN Indeed, there are indications that these drugs may mediate their effects through cellular signaling pathways including second messengers and inflammatory cytokines. Here, we focus on ion channelopathies as causal mechanisms for CPIN and review the data from both pre-clinical animal models and from human studies with the aim of facilitating the development of appropriate strategies to prevent and/or treat CPIN.

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“…Although known risk factors such as smoking and alcohol intake are often recorded, other variables believed to increase risk are often neglected. Several factors implicated in a higher risk of opioid misuse are male gender, younger age, reporting higher pain intensity, having a family member with opioid misuse, a history of sexual or physical abuse, the presence of anxiety, depression, posttraumatic stress disorder, or a history of serious psychiatric illness .…”

Section: Risk Assessment and Monitoringmentioning

confidence: 99%

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

Paice

2019

The Oncologist

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The primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imperative to include a thorough risk assessment when conducting a comprehensive pain evaluation. This information is then used to triage pain relief interventions based upon the degree of risk, including whether or not to incorporate opioids into the plan of care. Risk mitigation strategies, incorporating universal precautions, are implemented to assess, monitor, and reduce the potential for opioid misuse. Universal precautions include strategies such as the use of urine toxicology, state prescription drug monitoring programs, and agreements. Ongoing monitoring is conducted with the goal being to identify aberrant behaviors early so that they can be addressed and managed appropriately. Referral to addiction specialists may be warranted when substance use disorder precludes safe use of opioids. Implications for Practice Throughout the trajectory of cancer care, opioid use is often indicated, and, in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.

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Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline

Cited by 429 publications

References 96 publications

OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings

OPRM1 c.118A>G Polymorphism and Duration of Morphine Treatment Associated with Morphine Doses and Quality-of-Life in Palliative Cancer Pain Settings

Ion channels and neuronal hyperexcitability in chemotherapy-induced peripheral neuropathy

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

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