Pain in cancer survivors; filling in the gaps

Brown, Matthew R.D.; Farquhar-Smith, Paul

doi:10.1093/bja/aex202

Cited by 46 publications

(31 citation statements)

References 171 publications

(150 reference statements)

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“…As survival time has increased with two-, three-, and four-drug combination regimens, the number of cancer survivors presenting with chronic pain has increased as well. The concept of being a "cancer survivor" is relatively new, without a consensus on its definition, but it is usually related to a patient who lives with and beyond cancer [96].…”

Section: Pain In Cancer Survivorsmentioning

confidence: 99%

Pain Management in Patients with Multiple Myeloma: An Update

Coluzzi

Rolke

Mercadante³

2019

Cancers

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Most patients with multiple myeloma (MM) suffer from chronic pain at every stage of the natural disease process. This review focuses on the most common causes of chronic pain in MM patients: (1) pain from myeloma bone disease (MBD); (2) chemotherapy-induced peripheral neuropathy as a possible consequence of proteasome inhibitor therapy (i.e., bortezomib-induced); (3) post-herpetic neuralgia as a possible complication of varicella zoster virus reactivation because of post-transplantation immunodepression; and (4) pain in cancer survivors, with increasing numbers due to the success of antiblastic treatments, which have significantly improved overall survival and quality of life. In this review, non-pain specialists will find an overview including a detailed description of physiopathological mechanisms underlying central sensitization and pain chronification in bone pain, the rationale for the correct use of analgesics and invasive techniques in different pain syndromes, and the most recent recommendations published on these topics. The ultimate target of this review was to underlie that different types of pain can be observed in MM patients, and highlight that only after an accurate pain assessment, clinical examination, and pain classification, can pain be safely and effectively addressed by selecting the right analgesic option for the right patient.

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“…Our cohort of older BMT survivors had a 2.5‐fold higher risk of reporting chronic/severe pain in comparison with a sibling cohort. Current efforts are underway to increase the understanding of the underlying etiology of chronic/severe pain in cancer survivors, such as neuropathies (chemotherapy‐induced, postoperative pain syndrome), rheumatologic pain (arthralgias), skeletal pain (osteonecrosis secondary to chronic steroid use), gastrointestinal pain (gastritis), and genitourinary pain (cystitis) . Specifically in BMT patients, pain persisting after BMT has been shown to be attributable to cGVHD, chemotherapy‐induced peripheral neuropathies, chronic steroid–induced osteopenia, and opportunistic infections (eg, herpes zoster) .…”

Section: Discussionmentioning

confidence: 99%

Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report

Farrukh

Hageman

Chen

et al. 2020

Cancer

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BACKGROUND: Blood or marrow transplantation (BMT) is increasingly offered to older adults with hematologic malignancies; however, their risk for severe pain is poorly understood. Using the Bone Marrow Transplant Survivor Study, the current study investigated the prevalence and predictors of pain after BMT (allogeneic or autologous) as well as its association with physical performance impairments and frailty. METHODS: The cohort included 736 patients with hematologic malignancies who underwent BMT at an age ≥ 60 years at 1 of 3 transplant centers between 1974 and 2014 and survived ≥2 years after BMT; 183 unaffected siblings also participated. Study participants reported on 4 pain domains (nonminor everyday pain, moderate to severe bodily pain, prolonged pain, and moderate to extreme pain interference), and the presence of 1 or more domains was indicative of a severe and/or life-interfering pain composite variable. RESULTS: Overall, 39.4% of the BMT survivors reported severe pain with 2.6-fold greater odds of reporting pain in comparison with sibling controls. Among BMT recipients, those with less education, lower incomes, and active chronic graft-versus-host disease had higher odds of reporting pain. In multivariable analyses, BMT survivors with pain were more likely to have impaired physical performance and were more likely to meet the frailty criteria. BMT survivors reported higher use of pain medications (17.8% vs 9.3%) and opioid pain medications (6.5% vs 2.2%) in comparison with sibling controls. CONCLUSIONS: Nearly 40% of older BMT survivors who were followed for a median of 5 years after BMT reported pain, and BMT survivors had 2.6-fold higher odds of reporting severe, nonminor or life-interfering pain in comparison with siblings.

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“…Broadly speaking, these syndromes can be due to chemotherapy and hormonal therapies (such as chemotherapy-induced peripheral neuropathy, bone complications, and joint and muscle pain), radiation therapy (such as pain related to fistulous tracks, radiation-associated cystitis and enteritis, and radiationassociated brachial plexopathy), graft-versus-host disease, and surgical procedures (such as lymphedema, phantom pain syndromes, post-thoracotomy pain, and nerve pain,). 11,16,17 The management of these cancer pain syndromes can be complicated, particularly as patients live further into survivorship. When moderate or severe cancer pain complicates active disease-directed treatments, the use of opioid analgesics and nonopioid co-analgesic medications is accepted as a crucial component of cancer care, particularly since pain is often conceptualized as secondary to the cancer itself and/or treatment toxicities.…”

Section: Common Pain Syndromes In Cancer Survivorshipmentioning

confidence: 99%

Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship

Goodlev

DiScala

Darnall

et al. 2019

Journal of Palliative Medicine

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Background: Palliative care (PC) teams increasingly care for patients with cancer into survivorship. Cancer survivorship transcends distinctions between acute, chronic, malignant, and nonmalignant pain. Partnering with oncologists, PC teams manage pain that persists after disease-directed treatment, evaluate changing symptoms as possible signs of cancer recurrence, taper opioids and mitigate risk of opioid misuse, and manage comorbid opioid use disorder (OUD). While interdisciplinary guidelines exist for pain management in survivorship, there is a need to develop a conceptual model that fully translates the biopsychosocial framework of PC into survivorship pain management. Objective: This review frames a model for pain management in cancer survivorship that balances analgesia with the imperative to minimize risk of OUD, recognizes signs of disease recurrence, and provides whole-person care. Methods: Comprehensive narrative review of the literature. Results: Little guidance exists for co-management of pain, psychological distress, and opioid misuse in survivorship. We identified themes for whole-person pain management in survivorship: use of opioids and coanalgesic medications to prevent recurrent pain from residual tissue damage following cancer treatment, opioid tapering to the lowest effective dose, utilization of nonpharmacologic psychological interventions shown to reduce pain, screening for and management of OUD in partnership with addiction medicine specialists, maintaining vigilance for disease recurrence, and engaging in shared medical decision making. Conclusions: The management of pain in cancer survivorship is complex and requires interdisciplinary care that balances analgesia with the imperative to reduce long-term inappropriate opioid use and manage OUD, while maintaining therapeutic presence with patients in the spirit of PC.

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“…In cancer, NP may be the result of surgery, chemotherapy and/or radiotherapy, and through other treatments or specific disease mechanisms. 1 Pain with neuropathic features is more prevalent than generally realized, with population-based studies finding that 7-10% of adults are affected. 12 NP is more distressing than nociceptive pain, with a greater impact on life and health, 13 and the impact is more dependent on its severity than its underlying cause.…”

Section: Neuropathic Painmentioning

confidence: 99%

“…Brown and Farquhar-Smith list the possible causes: pain from the tumour (including neuropathies associated with haematological malignancy); bone pain; post-surgical pain; neuropathy induced by chemotherapy, biological agents, monoclonal antibodies or aromatase inhibitors; and radiation-induced pain. 1 They describe the latest knowledge of the biological mechanisms of each of these, such as the host of cytokines and growth factors released by the tumour and stromal cells that lead to neuronal sensitization, and encourage us by indicating how this knowledge is leading to new potential treatments. Emphasising that a 'one size fits all' approach to treating pain in cancer survivors is unhelpful, they summarise the treatments available and the evidence for their effectiveness.…”

Section: Box 1 Examples Of Neupsig Outputsmentioning

confidence: 99%

NeuPSIG: investing in solutions to the growing global challenge of neuropathic pain

Smith

Raja

2017

British Journal of Anaesthesia

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23. Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth 2013; 111: 711-20 24. Buggy DJ, Hemmings HC. Special issue on anaesthesia and cancer. Br J Anaesth 2014; 113: i1-3 25. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618-25 26. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008; 101: 77-86 27. Lö tsch J, Ultsch A, Kalso E. Prediction of persistent postsurgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis. Br J Anaesth 2017; 119: 821-9 28. Palmisani S, Arcioni R, De Blasi RA, et al. Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind, randomized, active-controlled trial. Br J Anaesth 2017; 119: 792-802 29. Goswami S, Kundra P, Bhattacharyya J. Pectoral nerve block1 versus modified pectoral nerve block2 for postoperative pain relief in patients undergoing modified radical mastectomy: a randomized clinical trial. Br J Anaesth 2017; 119: 830-5 30. Cata JP, Guerra CE, Chang GJ, et al. Non-steroidal antiinflammatory drugs in the oncological surgical population: beneficial or harmful? A systematic review of the literature. Br J Anaesth 2017; 119: 750-64 31. Poply K, Mehta V. The dilemma of interventional pain trials: thinking beyond the box. Br J Anaesth 2017; 119: 718-9 32. Joshi G, Kehlet H. Guidelines for perioperative pain management: need for re-evaluation. Br J Anaest 2017; 119: 720-2 33. Sikandar S, Patel R, Patel S, Sikander S, Bennett DL, Dickenson AH. Genes, molecules and patients-emerging topics to guide clinical pain research.

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Pain in cancer survivors; filling in the gaps

Cited by 46 publications

References 171 publications

Pain Management in Patients with Multiple Myeloma: An Update

Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report

Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship

NeuPSIG: investing in solutions to the growing global challenge of neuropathic pain

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