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Vol 17, No 4 (2023)
Guidelines
Published online: 2023-12-22
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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

Wojciech Leppert12, Jerzy Wordliczek3, Małgorzata Malec-Milewska4, Magdalena Kocot-Kępska5, Jarosław Woroń6, Renata Zajączkowska3, Jan Dobrogowski5, Maciej Krzakowski7, Małgorzata Krajnik8
Palliat Med Pract 2023;17(4):187-207.
Affiliations
  1. Chair of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, Poland
  2. University Clinical Hospital in Poznań, Poland
  3. Department of Interdisciplinary Intensive Care, Jagiellonian University Collegium Medicum, Cracow, Poland
  4. Department of Anesthesiology and Intensive Therapy, Center for Postgraduate Medical Education, Warsaw, Poland
  5. Department of Pain Research and Therapy, Jagiellonian University Collegium Medicum, Cracow, Poland
  6. Department of Clinical Pharmacology, Chair of Pharmacology, Jagiellonian University Collegium Medicum, Cracow, Poland
  7. Department of Lung Cancer and Thoracic Tumors, National Oncology Institute of Maria Sklodowska-Curie, National Research Institute, Warsaw, Poland
  8. Chair of Palliative Care, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland

open access

Vol 17, No 4 (2023)
Guidelines for diagnostic and therapeutic management
Published online: 2023-12-22

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.

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.

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Keywords

cancer, clinical assessment, pain, pharmacotherapy, treatment

About this article
Title

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

Journal

Palliative Medicine in Practice

Issue

Vol 17, No 4 (2023)

Article type

Guidelines

Pages

187-207

Published online

2023-12-22

Page views

396

Article views/downloads

191

Bibliographic record

Palliat Med Pract 2023;17(4):187-207.

Keywords

cancer
clinical assessment
pain
pharmacotherapy
treatment

Authors

Wojciech Leppert
Jerzy Wordliczek
Małgorzata Malec-Milewska
Magdalena Kocot-Kępska
Jarosław Woroń
Renata Zajączkowska
Jan Dobrogowski
Maciej Krzakowski
Małgorzata Krajnik

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