Palliative care
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
Cancer pain is a chronic pain distinct from that associated with acute events such as trauma, post-operative pain or a toothache. An important feature for its management is that it will often be associated with a significant emotional component alongside the physical cause of pain. Most cancer patients have associated anxiety, fear, depression and anger, which will modulate their perception of pain and attention to these features will be of equal importance to the use of analgesic drugs. Three components to the pain of advanced cancer have been described: PhysicalEmotionalSpiritual
The Psychosocial and Physical Challenges of Cancer
Scott Temple in Brief Cognitive Behavior Therapy for Cancer Patients, 2017
In addition to the psychological effects of being diagnosed and treated for cancer, there are physical effects of cancer and cancer treatment, which intertwine with and influence adaptive behavior and coping. The most common physical effects are fatigue and pain. Between 60% and 90% of patients in treatment for cancer may report clinically significant fatigue (Flechtner & Bottomley, 2003), with fatigue continuing to be a potential problem for years after the completion of treatment. CBT has demonstrated efficacy in managing the effects of fatigue and pain in cancer patients (Jacobsen & Andrykowski, 2015). Significant pain, for example, affects perhaps 25% to 33% of patients (Jacobsen & Andrykowski, 2015). The causes and maintaining factors in cancer pain are complex and include the disease site and severity; the use of surgical, radiation, or chemotherapies, and psychological factors that contribute to pain. The latter include a tendency toward a catastrophizing cognitive response, hopelessness, isolation, and withdrawal, in addition to anxious arousal and worry. The response of caregivers to pain may also serve as a maintaining factor for pain.
Clinical decision based on evidence
Francis Guillemin, Alain Leplège, Serge Briançon, Elisabeth Spitz, Joël Coste in Perceived Health and Adaptation in Chronic Disease, 2017
Cancer pain is multidimensional and comprehensive pain assessment is essential. The most frequently used standardized scales are the nonspecific Brief Pain Inventory (BPI), the Pain Treatment Acceptability Scale (PTA), and the Memorial Symptom Assessment Scale (MSAS). However, patients with complex pain syndromes often require more intensive therapeutic programs and more time to achieve stable pain control (Nekolaichuk et al., 2013). To be more specific to cancer, the Edmonton Classification System for Cancer Pain (ECS-CP) was developed by practitioners wishing to be able to foresee which patients will be more difficult or time consuming to manage and for whom increasing the opioid dosage is not a satisfactory outcome. The ECS-CP's goals may also be to help the practitioner decide whether a new therapy is preferable to a standard therapy, or determine whether a therapeutic regimen is better than supportive care only, considering the patients’ survival time (Fainsinger and Nekolaichuk, 2008).
Pain management in multiple myeloma
Published in Expert Review of Quality of Life in Cancer Care, 2018
Fibers belonging to the spinomesencephalic tract play an important role in pain control. The complexity of analgesia system is the reason why pain tolerance threshold is extremely variable [14]. Cancer pain should be considered a special category of pain with its peculiarities and incompletely understood etiology [15]. Pathophysiology of cancer pain involves both inflammatory and neuropathic mechanisms [16]. Malignant cells secrete a lot of algogenic mediators responsible for perineural invasion, together with microenvironment inflammation culminating to tissues damage and hyperalgesia [17]. These substances influence responsiveness to opioids by reducing expression of μ opioid receptors on dorsal root ganglia. Furthermore, the activation of N-methyl-D-aspartate (NMDA) receptors by algogenic mediators may reduce response to morphine [18,19].
Challenges and concerns of persistent opioid use in cancer patients
Published in Expert Review of Anticancer Therapy, 2018
Laxmaiah Manchikanti, Kavita N. Manchikanti, Alan D. Kaye, Adam M. Kaye, Joshua A. Hirsch
Cancer is among the leading causes of morbidity and mortality worldwide, with about 14 million new cases and over 8 million deaths annually – approximately 13% of deaths worldwide [1]. As a result of extraordinary advancements in diagnosis and treatment, over 15 million individuals with a history of cancer, excluding nonmelanomatous skin cancers, are living in the United States [1–5]. Further, in the United Kingdom in 2014, there were approximately 350,000 new cases of cancer annually, with around 50% of patients surviving for 10 years or more after diagnosis [6]. It is well known that cancer pain is one of the most featured symptoms associated with the disease. However, with an increasing number of cancer survivors, multiple concerns come into light such as the prevalence rates of pain in cancer survivors, chronic cancer pain, multiple treatment options and their adequacy, comorbidities, and adverse consequences and complications related to various treatment modalities [1–5,7–12].
A narrative review of buprenorphine in adult cancer pain
Published in Expert Review of Clinical Pharmacology, 2020
Matthew Degnan, Shaker A. Mousa
Cancer-associated pain can have many causes, which makes management a multifaceted and complex task. The most common type of pain experienced by patients with cancer is somatic pain, and this is most commonly caused by a solid tumor [7]. Cancer pain is constant and needs well-managed relief using various approaches. A related origin of pain in solid tumor cancers is postoperative pain. However, while not all cancers have solid tumors, pain of different etiologies can still be common. Understanding the etiology and pathophysiology of the pain a patient is experiencing is fundamental for adequate treatment. The current understanding of the pathophysiologic pathways involved in adult cancer pain are associated with cancer and its therapy. Concomitant use of pain relief with anticancer medications dictate the use of analgesics with the fewest drug-drug interactions and the most favorable metabolic and excretion profiles.
Related Knowledge Centers
- Cancer Staging
- Chronic Pain
- Intellectual Disability
- Pain Management
- Cancer
- Malignancy
- Chemotherapy
- Depression
- Radiation Therapy
- Pain Management In Children