State of Art of Managing Pain in Patients With Cancer

Dalal, Shalini; Tanco, Kimberson; Bruera, Éduardo

doi:10.1097/ppo.0b013e3182a631c5

Cited by 22 publications

(20 citation statements)

References 93 publications

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“…The aetiology of pain in cancer is multifaceted; it can be tumour related, treatment related, or unrelated to the underlying cancer condition . The adequate assessment of the diverse types and causes of cancer pain remains a demanding task for the treating physician and a necessary prerequisite for satisfactory pain management . The pharmacotherapeutic treatment of cancer pain is based on the analgesic ladder approach introduced 30 years ago by the WHO .…”

Section: Discussionmentioning

confidence: 99%

“…Adequate assessment and management of pain is therefore a major challenge in palliative care. A vast amount of studies are aimed at optimizing opioid‐based analgesic treatment by analysing appropriate drug and dose selection as well as the treatment of opioid side effects . Comparatively little research has focused on the effectiveness of non‐opioid analgesics in this context.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review and meta‐analysis on non‐opioid analgesics in palliative medicine

Schüchen

Mücke

Marinova

et al. 2018

J cachexia sarcopenia muscle

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Non‐opioid analgesics are widely used for pain relief in palliative medicine. However, there is a lack of evidence‐based recommendations addressing the efficacy, tolerability, and safety of non‐opioids in this field. A comprehensive systematic review and meta‐analysis on current evidence can provide a basis for sound recommendations in clinical practice. A database search for controlled trials on the use of non‐opioids in adult palliative patients was performed in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, and EMBASE from inception to 18 February 2018. Endpoints were pain intensity, opioid‐sparing effects, safety, and quality of life. Studies with similar patients, interventions, and outcomes were included in the meta‐analyses. Our systematic search was able to only identify studies dealing with cancer pain. Of 5991 retrieved studies, 43 could be included (n = 2925 patients). There was no convincing evidence for satisfactory pain relief by acetaminophen alone or in combination with strong opioids. We found substantial evidence of moderate quality for a satisfactory pain relief in cancer by non‐steroidal anti‐inflammatory drugs (NSAIDs), flupirtine, and dipyrone compared with placebo or other analgesics. There was no evidence for a superiority of one specific non‐opioid. There was moderate quality of evidence for a similar pain reduction by NSAIDs in the usual dosage range compared with up to 15 mg of morphine or opioids of equianalgesic potency. The combination of NSAID and step III opioids showed a beneficial effect, without a decreased tolerability. There is scarce evidence concerning the combination of NSAIDs with weak opioids. There are no randomized‐controlled studies on the use of non‐opioids in a wide range of end‐stage diseases except for cancer. Non‐steroidal anti‐inflammatory drugs, flupirtine, and dipyrone can be recommended for the treatment of cancer pain either alone or in combination with strong opioids. The use of acetaminophen in the palliative setting cannot be recommended. Studies are not available for long‐term use. There is a lack of evidence regarding pain treatment by non‐opioids in specific cancer entities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis on non‐opioid analgesics in palliative medicine

Schüchen

Mücke

Marinova

et al. 2018

J cachexia sarcopenia muscle

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“…8 In the clinical context, one never sees pain. The clinician observes an individual patient's emotional responses to his or her pain, which typically manifests as distress and suffering.…”

Section: Nature Of Painmentioning

confidence: 99%

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

O’Brien

Kane

2014

British Journal of Pain

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The vast majority of cancer patients will experience pain during the course of their illness. Thankfully, in most instances, the consistent application of analgesic guidelines, tailored to the unique needs of each individual patient, will deliver a satisfactory outcome. These guidelines recommend the skilled use of analgesic medications, often in conjunction with a range of adjuvant therapies as may be required. Despite the consistent and rational application of such strategies, it is recognised that a small but significant proportion of cancer patients continue to experience more refractory pain. In addition, these patients may experience a plethora of unwanted dose-limiting side effects associated with their analgesic medication, sometimes even at low dose. All such patients with more complex and refractory pain syndromes require a more comprehensive review and many will require interventional therapy and/or adjuvant approaches. Unfortunately, the availability and accessibility of such services are variable. Even in circumstances in which palliative medicine and pain services co-exist in the same region, there may be poor integration between the two services. Each specialty area holds a unique set of skills and competencies, yet there is considerable overlap. Patient care and outcomes will be enhanced by establishing more formal relationships between these two specialty areas.

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“…The symptom and the resources may differ, but the framework of the model stays the same. Finally, because other concepts as SDM have shown to be essential in cancer pain management and also show overlap with empowerment, these were included too.…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated papers discussing empowerment or empowerment‐related concepts in relation to pain management in patients with cancer. As other constructs, such as self‐efficacy and shared decision making (SDM), have shown to be essential in cancer pain management and also show overlap with empowerment, these were included too. Therefore, to obtain insight in the concept empowerment, related concepts should be taken into account.…”

Section: Methodsmentioning

confidence: 99%

Patient empowerment in cancer pain management: an integrative literature review

et al. 2014

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Objective: More than 50% of patients with cancer experience pain. Patient empowerment has been highlighted as central to success in pain management. Up to now, no clear model for this patient group exists, yet several strategies to empower patients have been used in clinical practice. This review examines how empowerment or related concepts have been described in relation to pain management in patients with cancer. With the help of a conceptual model, recommendations for clinical practice are provided.Methods: An integrative review was conducted, using the databases PubMed, CINAHL and PsycINFO. We evaluated papers discussing empowerment or related concepts in relation to pain management in patients with cancer. We analyzed the term 'empowerment' semantically.Results: From a total of 5984 identified papers, 34 were included for analysis. Empowerment has been described with the concepts self-efficacy, active patient participation, increasing abilities, and control of life. Most papers focus on pain treatment induced by the professional caregiver or on the active involvement of the patient, and not on the combination of both. The following elements of empowerment could be discriminated: role of the patient, role of the professional, resources, self-efficacy, active coping, and shared decision making.Conclusions: On the basis of these findings, we propose a conceptual model to empower patients in controlling cancer pain. We recommend focusing on pain treatment given by the professional, on the active involvement of the patient, and on the interaction of both. Our model might also be useful for other patient groups or specific contexts, especially in symptom management.

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State of Art of Managing Pain in Patients With Cancer

Cited by 22 publications

References 93 publications

Systematic review and meta‐analysis on non‐opioid analgesics in palliative medicine

Systematic review and meta‐analysis on non‐opioid analgesics in palliative medicine

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

Patient empowerment in cancer pain management: an integrative literature review

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