Pharmacologic Management of Persistent Pain in Cancer Survivors

Abstract

Improvements in screening, diagnosis and treatment of cancer has seen cancer mortality substantially diminish in the past three decades. It is estimated there are almost 20 million cancer survivors in the USA alone, but some 40% live with chronic pain after completing treatment. While a broad definition of survivorship that includes all people living with, through and beyond a cancer diagnosis-including those with active cancer-is often used, this narrative review primarily focuses on the management of pain in people who are disease-free after completing primary cancer treatment as adults. Chronic pain in this population needs a different approach to that used for people with a limited prognosis. After describing the common chronic pain syndromes caused by cancer treatment, and the pathophysiologic mechanisms involved, the pharmacologic management of entities such as post-surgical pain, chemotherapy-induced neuropathy, aromatase inhibitor musculoskeletal syndrome and checkpoint inhibitor-related pain are described. The challenges associated with opioid prescribing in this population are given special attention. Expert guidelines on pain management in cancer survivors now recommend a combination of pharmacologic and non-pharmacologic modalities, and these are also briefly covered.

Data Analysis for Modeling the Effect of Acupuncture on Postchemotherapy Cancer Fatigue in Gynecologic Oncology Patients

“…Although the mechanism of the effect of acupuncture in the treatment of this disease is not clear, some studies have shown that acupuncture and its related therapies (such as auricular acupuncture and warm acupuncture) have great potential as an adjuvant therapy to alleviate CRF in patients and improve the quality of survival of patients, and the clinical studies of acupuncture and its related therapies in recent years are summarized, analyzed, and summarized as follows. A randomized double-blind controlled trial was conducted by [ 12 ], which included 28 patients with CRF of lung cancer, with acupoints selected as 45 min/time, 2 times/week, and continued treatment for 4 weeks with a 2-week follow-up, while the sham acupuncture group took the same acupoints but without needles into the skin [ 13 ].…”

Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors

“…Finally, survivors who have completed treatment have different concerns and priorities related to their health care, affecting their communication with their care team. [20] We used the Consolidated Criteria for Reporting Qualitative (COREQ) Research to guide data collection, analysis and reporting. [21].…”

The Contribution of Cancer-Specific Psychosocial Factors to the Pain Experience in Cancer Survivors

“…7 Common chronic cancer pain syndromes include chemotherapy-induced peripheral neuropathy, lymphedema, postsurgical pain, and arthralgias from hormonal or molecular-based treatments. 8 Current recommendations advise that chronic cancer-related pain be treated using a multimodal approach that incorporates pharmacologic and nonpharmacologic interventions, with an emphasis on sparing the use of long-term opioids. 9,10 The optimal treatment of chronic pain involves interdisciplinary management, with key nursing contributions to pain care being well-documented.…”

“…Often chronic cancer-related pain is related to treatments such as surgery, radiation, chemotherapy, or other pharmacologic treatments 7 . Common chronic cancer pain syndromes include chemotherapy-induced peripheral neuropathy, lymphedema, postsurgical pain, and arthralgias from hormonal or molecular-based treatments 8 . Current recommendations advise that chronic cancer-related pain be treated using a multimodal approach that incorporates pharmacologic and nonpharmacologic interventions, with an emphasis on sparing the use of long-term opioids 9,10 .…”