Vol 17, No 4 (2023)
Guidelines
Published online: 2023-12-22
Diagnostic and therapeutic management of cancer patients with pain: recommendations of the Expert Group of the Polish Association for Palliative Care, Polish Association for the Study of Pain, and Polish Association of Clinical Oncology
Palliat Med Pract 2023;17(4):187-207.
Abstract
In order to elaborate diagnostic and therapeutic recommendations regarding the management of cancer patients with pain, a narrative review of the literature in PubMed and Cochrane database was conducted for the period of 2000–2022. An Expert Group of three scientific associations: Polish Association of Palliative Care, Polish Association for the Study of Pain, and Polish Association of Clinical Oncology was appointed, which made a literature review and formulated guidelines with strength of recommendations and quality of evidence. To achieve optimal effect of pain treatment cancer patients require complex clinical assessment of pain with detailed recognition of pathophysiology, intensity and time frame (baseline and breakthrough — episodic) of pain. Pain evaluation should encompass other symptoms, comorbidities, disturbances in psychological, social, and spiritual dimensions, which may induce patients’ suffering and total pain appearance. An important role plays anticancer local and systemic treatment, which may induce or exacerbate pain induced by cancer or comorbidities. A standard approach in patients with chronic pain in the course of cancer and other diseases is based on World Health Organization (WHO) analgesic ladder algorithm, which is supplemented with non-pharmacological management. It is recommended an individual approach in pain treatment depending on clinical situation of a concrete patient. Efforts should be made to effectively manage other symptoms, which accompany cancer. An introduction of specific treatment taking into account given pathophysiology, time frame and intensity of pain increase effectiveness and significantly shorten time necessary to achieve effective analgesia, and moreover contribute to decrease intensity and frequency of adverse effects of analgesics used.
Keywords: cancerclinical assessmentpainpharmacotherapytreatment
References
- Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020; 161(9): 1976–1982.
- Higginson IJ, Murtagh F. Cancer pain epidemiology. In: Bruera EJ, Portenoy RK. ed. Cancer Pain. Assessment and Management. Cambridge University Press 2010: 37–52.
- Breivik H, Cherny N, Collett B, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009; 20(8): 1420–1433.
- van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007; 18(9): 1437–1449.
- De Walden-Gałuszko K, Majkowicz M. Psychologiczno-kliniczna ocena bólu przewlekłego. Wskazania dla lekarzy pierwszego kontaktu oraz poradni przeciwbólowych i paliatywnych. Akademia Medyczna, Gdańsk 2003.
- Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114(1-2): 29–36.
- Turczyn P, Kosińska B, Janikowska-Hołoweńko D, et al. Translation and cross-cultural adaptation of the Polish Central Sensitization Inventory. Reumatologia. 2019; 57(3): 129–134.
- https://opiekunrodzinny.pl/jestem-opiekunem/opiekuje-sie-chorym-doroslym/opieka-nad-chorym-porady/skuteczne-leczenie-bolu/leczenie-bolu-w-praktyce/ (21.04.2023).
- den Boer C, Dries L, Terluin B, et al. Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments. J Psychosom Res. 2019; 117: 32–40.
- Løhre ET, Klepstad P, Bennett MI, et al. European Association for Palliative Care Research Network. From “Breakthrough” to “Episodic“ Cancer Pain? A European Association for Palliative Care Research Network Expert Delphi Survey Toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations. J Pain Symptom Manage. 2016; 51(6): 1013–1019.
- Mercadante S, Radbruch L, Caraceni A, et al. Steering Committee of the European Association for Palliative Care (EAPC) Research Network. Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer. 2002; 94(3): 832–839.
- Leppert W, Forycka M, Nosek K. Breakthrough and episodic pain in cancer patients – a new look. Med Paliat. 2016; 8(1): 9–16.
- Caraceni A, Hanks G, Kaasa S, et al. European Palliative Care Research Collaborative (EPCRC), European Association for Palliative Care (EAPC). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012; 13(2): e58–e68.
- Fallon M, Giusti R, Aielli F, et al. ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018; 29(Suppl 4): iv166–iv191.
- WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents 2018.
- Bennett MI, Eisenberg E, Ahmedzai SH, et al. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain. 2019; 23(4): 660–668.
- Paice JA, Bohlke K, Barton D, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023; 41(4): 914–930.
- Corli O, Floriani I, Roberto A, et al. CERP STUDY OF PAIN GROUP (List of collaborators). Are strong opioids equally effective and safe in the treatment of chronic cancer pain? A multicenter randomized phase IV 'real life' trial on the variability of response to opioids. Ann Oncol. 2016; 27(6): 1107–1115.
- Reid CM, Gooberman-Hill R, Hanks GW. Opioid analgesics for cancer pain: symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer. Ann Oncol. 2008; 19(1): 44–48.
- De Conno F, Ripamonti C, Fagnoni E, et al. MERITO Study Group. The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during 'titration phase' in patients with cancer pain. Palliat Med. 2008; 22(3): 214–221.
- Bandieri E, Romero M, Ripamonti CI, et al. Early Strong Opioid Treatment Study (ESOT) Investigators. Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain. J Clin Oncol. 2016; 34(5): 436–442.
- Riley J, Branford R, Droney J, et al. Morphine or oxycodone for cancer-related pain? A randomized, open-label, controlled trial. J Pain Symptom Manage. 2015; 49(2): 161–172.
- Zecca E, Brunelli C, Bracchi P, et al. Comparison of the Tolerability Profile of Controlled-Release Oral Morphine and Oxycodone for Cancer Pain Treatment. An Open-Label Randomized Controlled Trial. J Pain Symptom Manage. 2016; 52(6): 783–794.e6.
- Ahmedzai SH, Nauck F, Bar-Sela G, et al. A randomized, double-blind, active-controlled, double-dummy, parallel-group study to determine the safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate/severe, chronic cancer pain. Palliat Med. 2012; 26(1): 50–60.
- Ahmedzai SH, Leppert W, Janecki M, et al. Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain. Support Care Cancer. 2015; 23(3): 823–830.
- Wang DD, Ma TT, Zhu HD, et al. Transdermal fentanyl for cancer pain: Trial sequential analysis of 3406 patients from 35 randomized controlled trials. J Cancer Res Ther. 2018; 14(Supplement): S14–S21.
- Zeppetella G, Davies A, Eijgelshoven I, et al. A network meta-analysis of the efficacy of opioid analgesics for the management of breakthrough cancer pain episodes. J Pain Symptom Manage. 2014; 47(4): 772–785.e5.
- Cachia E, Ahmedzai SH. Transdermal opioids for cancer pain. Curr Opin Support Palliat Care. 2011; 5(1): 15–19.
- Schmidt-Hansen M, Bromham N, Taubert M, et al. Buprenorphine for treating cancer pain. Cochrane Database Syst Rev. 2015; 2015(3): CD009596.
- Zajączkowska R, Przewłocka B, Kocot-Kępska M, et al. Tapentadol - A representative of a new class of MOR-NRI analgesics. Pharmacol Rep. 2018; 70(4): 812–820.
- Wiffen PJ, Derry S, Naessens K, et al. Oral tapentadol for cancer pain. Cochrane Database Syst Rev. 2015; 2015(9): CD011460.
- Nicholson AB, Watson GR, Derry S, et al. Methadone for cancer pain. Cochrane Database Syst Rev. 2017; 2(2): CD003971.
- Wiffen PJ, Wee B, Derry S, et al. Opioids for cancer pain — an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017; 7(7): CD012592–10.1002/14651858. CD012592.pub2.
- Wordliczek J, Kotlińska-Lemieszek A, Leppert W, et al. Pharmacotherapy of pain in cancer patients - recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. Pol Przegl Chir. 2018; 90(4): 55–84.
- Leppert W, Wordliczek J. Recommendations for assessment and management of pain in cancer patients. Oncol Clin Pract. 2018; 14(1): 1–14.
- Kalso E. Clinical pharmacology of opioids in the treatment of pain. In: Mogil J. ed. Pain 2010 — An Updated Review. IASP Press, Seattle 2010: 207–216.
- Ruano A, García-Torres F, Gálvez-Lara M, et al. Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2022; 63(5): e505–e520.
- Pyszora A, Jagielski D, Jagielska A. Physiotherapy for mysofascial pain syndrome in cancer patient. Med Paliat Prakt. 2015; 9(2): 55–58.
- Hurlow A, Bennett MI, Robb KA, et al. Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. Cochrane Database Syst Rev. 2012; 2012(3): CD006276.
- Paley CA, Johnson MI, Tashani O. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2015; 2015(10): CD007753.
- He Y, Guo X, May BH, et al. Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis. JAMA Oncol. 2020; 6(2): 271–278.
- Yang J, Wahner-Roedler DL, Zhou X, et al. Acupuncture for palliative cancer pain management: systematic review. BMJ Support Palliat Care. 2021; 11(3): 264–270.
- Kocot–Kępska M, Mitka K, Rybicka M, et al. The role of physical activity in cancer patients: a narrative review. Palliat Med Pract. 2021; 15(3): 254–262.
- Warth M, Zöller J, Köhler F, et al. Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis. Curr Oncol Rep. 2020; 22(1): 3.
- Braunwalder C, Müller R, Glisic M, et al. Are Positive Psychology Interventions Efficacious in Chronic Pain Treatment? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med. 2022; 23(1): 122–136.
- Dworkin RH, O'Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010; 85(3 Suppl): S3–14.
- Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015; 14(2): 162–173.
- Miszczyk M, Wydmański J, Kocot-Kępska M, et al. Noninvasive celiac plexus radiosurgery in palliative treatment for patients with symptomatic pancreatic cancer. Contemp Oncol (Pozn). 2021; 25(2): 140–145.
- Garg R, Joshi S, Mishra S, et al. Evidence based practice of chronic pain. Indian J Palliat Care. 2012; 18(3): 155–161.
- Bhatnagar S, Gupta M. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain. Indian J Palliat Care. 2015; 21(2): 137–147.
