Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence

There is an increased interest in the use of cannabinoids in the treatment of symptoms in cancer and palliative care patients. Their multimodal action, in spite of limited efficacy, may make them an attractive alternative, particularly in patients with multiple concomitant symptoms of mild and moderate intensity. There is evidence to indicate cannabis in the treatment of pain, spasticity, seizures, sleep disorders, nausea and vomiting, and Tourette syndrome. Although the effectiveness of cannabinoids is limited, it was confirmed in neuropathic pain management and combination with opioids. A relatively favorable adverse effects profile, including no depressive effect on the respiratory system, may make cannabis complement a rather narrow armamentarium that is in the disposition of a palliative care professional.

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Principles of Assessment and Pain Management and Procedures in Pain Management

Hospice and Palliative Medicine and Supportive Care Flashcards ◽

10.1093/med/9780190633066.003.0004 ◽

2018 ◽

Author(s):

Francisco A. Loaiciga ◽

Suresh Reddy

Keyword(s):

Palliative Care ◽

Pain Management ◽

Interdisciplinary Approach ◽

Care Practice ◽

Clear Understanding ◽

Pain Mechanisms ◽

Single Presentation ◽

Basic Concepts ◽

Outpatient Settings ◽

Real Challenge

Pain has been a major concern in both inpatient and outpatient settings, particularly in patients with advanced diseases. In recent years, considerable progress has been made in the understanding of both acute and chronic pain mechanisms. The bio psychosocial experience of pain, whether it is a mixture or a single presentation of it’s different components, physical, psychological, social, or spiritual, may present a real challenge to both the patient and the treating team, and thus a clear understanding of it’s complexity, is of prime importance. Effective pain management involves an interdisciplinary approach using multimodal techniques, with the goal being to relieve the patient’s suffering. This chapter discusses basic concepts related to pain and its approach in routine palliative care practice.

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Using information and communication technologies to improve the management of pain from advanced cancer in the community: Qualitative study of the experience of implementation for patients and health professionals in a trial

Health Informatics Journal ◽

10.1177/1460458220906289 ◽

2020 ◽

Vol 26 (4) ◽

pp. 2435-2445

Author(s):

Julia Hackett ◽

Matthew J Allsop ◽

Sally Taylor ◽

Michael I Bennett ◽

Bridgette M Bewick

Keyword(s):

Palliative Care ◽

Pain Management ◽

Qualitative Study ◽

Information And Communication Technology ◽

Communication Technology ◽

Health Professionals ◽

Randomised Control Trial ◽

Care Practice ◽

Technology System ◽

Information And Communication

In cancer care, there are emerging information and communication technology systems being developed, enabling real-time information sharing between patients and health professionals. This study explored health professionals’ and patients’ perceptions of their engagement with an information and communication technology system for pain management to understand the mechanisms that could support implementation into routine palliative care practice. This was a qualitative study, embedded within a randomised control trial, using semi-structured face-to-face interviews. Data were analysed using thematic analysis. The role of health professionals was a key component to patient engagement with the information and communication technology system. Where patients engaged with the information and communication technology system, both patients and health professionals reported benefits to system use in addition to usual care. Implementation issues were identified that can be used to guide future system development to support pain management in the context of routine clinical care in palliative care services. Where interventions are dependent on multiple providers, collaborative working and consideration of the context within which they are set are needed.

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Opioid use disorder and chronic pain: challenges for palliative care practice

International Journal of Palliative Nursing ◽

10.12968/ijpn.2019.25.9.453 ◽

2019 ◽

Vol 25 (9) ◽

pp. 453-457

Author(s):

Brenda Peters-Watral

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Substance Use ◽

Pain Management ◽

Cancer Pain ◽

Opioid Use Disorder ◽

Care Practice ◽

Care Providers ◽

Opioid Use ◽

Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

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Barriers and Facilitators to Optimal Neuropathic Pain Management: SCI Consumer, Significant Other, and Health Care Provider Perspectives

Pain Medicine ◽

10.1093/pm/pnaa058 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2913-2924

Author(s):

Eva Widerstrom-Noga ◽

Kim D Anderson ◽

Salome Perez ◽

Alberto Martinez-Arizala ◽

Lindsey Calle-Coule ◽

...

Keyword(s):

Health Care ◽

Neuropathic Pain ◽

Pain Management ◽

Adverse Effects ◽

Qualitative Interviews ◽

Treatment Options ◽

Significant Others ◽

Barriers And Facilitators ◽

Care Providers ◽

Nonpharmacological Treatment

Abstract Objective Persistent neuropathic pain is a common and often severe consequence of spinal cord injury (SCI). There is a critical need to better understand how to overcome barriers and promote facilitators to optimal pain management. The present study was designed to identify, from the perspectives of persons living with SCI, their significant others, and SCI health care professionals, the barriers and facilitators to optimal pain management for intense neuropathic pain. Design Qualitative interviews. Setting University laboratory. Subjects People with SCI who had experienced intense neuropathic pain for a minimum of a year (N = 15), their significant others (N = 15), and SCI health care providers (N = 15). Methods Qualitative interviews were recorded, transcribed, and analyzed based on grounded theory using ATLAS.ti software. Results Inadequate access to care, information, or pain management expertise were frequently perceived barriers to optimal pain management across all three groups. Another major barrier was SCI stakeholders’ concerns regarding the risks of adverse effects and addiction to pain medication. Facilitators included having a better understanding of pain and available treatment options, effective patient–provider communication, resilience, and access to nonpharmacological treatment options. Conclusions Managing intense neuropathic pain poses significant challenges after SCI. SCI stakeholders felt that accessible treatment options were limited and primarily focused on pain medications with minimal benefit but with significant risks for addiction and adverse effects. Actionable facilitators to optimal pain management after SCI include education regarding neuropathic pain and treatment options for all stakeholders, better communication regarding neuropathic pain among stakeholders, and improved patient access to nonpharmacological treatment options.

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Potential innovative targets in the treatment of pain: Combined μ and NOP receptor agonists

Journal of Opioid Management ◽

10.5055/jom.2021.0659 ◽

2021 ◽

Vol 17 (4) ◽

pp. 277-283

Author(s):

Raphael J. Leo, MA, MD

Keyword(s):

Neuropathic Pain ◽

Pain Management ◽

Adverse Effects ◽

Acute Pain ◽

Opioid Analgesics ◽

Receptor Activation ◽

Preclinical Studies ◽

Nop Receptor ◽

Receptor Agonists ◽

Potential Target

Opioid analgesics are potent and widely used medications employed to manage moderate-to-severe acute pain; their utility in the management of chronic inflammatory and neuropathic pain is modest and is beset with adverse effects and concerns related to abuse and addiction. The discovery of the nonclassical opioid, ie, the nociception/orphanin receptor (NOP), has sparked interest into another possible analgesic target. Preclinical studies have demonstrated pain mitigating effects associated with NOP receptor activation while simultaneously reducing conventional μ-opioid-related adverse and euphoric effects. Consequently, agents possessing dual agonism of both μ and NOP receptor activations present an innovative and promising potential target for pain management.

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Pain management

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0008 ◽

2019 ◽

pp. 237-316

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Care Practice ◽

Total Pain ◽

Holistic Understanding ◽

Central Tenet ◽

The Common ◽

Palliative Setting

This chapter covers the theoretical and practical basis of managing patients with pain in the palliative setting. It includes a review of the common pharmacological, non-pharmacological and anaesthetic approaches to managing pain as well as emphasizing that all good care must be based on a holistic understanding. The concept of total pain has become a central tenet of palliative care practice. It recognizes that cancer pain is often a complex, chronic pain with multiple, coexisting causes. Effective management of cancer pain requires a multidisciplinary approach that addresses the patient’s concerns and fears, as well as treating the physical aspects of pain. As a result, the provision of analgesics should be combined with the provision of emotional, social, and spiritual supports.

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The management of pain

10.1093/med/9780199234356.003.0012 ◽

2010 ◽

Author(s):

Max Watson ◽

Caroline Lucas ◽

Andrew Hoy ◽

Jo Wells

Keyword(s):

Palliative Care ◽

Neuropathic Pain ◽

Pain Management ◽

Cancer Pain ◽

Breakthrough Pain ◽

Opioid Analgesics ◽

Physical Pain ◽

Patients With Cancer ◽

Transdermal Patches

This chapter covers physical pain in patients with cancer, assessment of pain, pain classification, principles of pain management, breakthrough pain, step 1 analgesics, step 2 analgesics, and step 3 analgesics. The chapter also covers opioid equivalence for transdermal patches, approximate equivalent doses for opioid analgesics for adults, neuropathic pain, anaesthetic procedures in palliative care, chemical neurolysis for cancer pain, and pain and difficulties in communication.

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Attitudes Toward Opioid Use for Chronic Pain: A Canadian Physician Survey

Pain Research and Management ◽

10.1155/2003/184247 ◽

2003 ◽

Vol 8 (4) ◽

pp. 189-194 ◽

Cited By ~ 86

Author(s):

Patricia K Morley-Forster ◽

Alexander J Clark ◽

Mark Speechley ◽

Dwight E Moulin

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Pain Management ◽

Physician Education ◽

Care Practice ◽

Pain Patient ◽

Computer Assisted ◽

Opioid Use ◽

Severe Chronic Pain ◽

Noncancer Pain

OBJECTIVES: To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians' attitudes toward the current management of chronic pain in Canada.DESIGN: A computer-assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).SETTING: A survey was conducted by Ipsos-Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.RESULTS: In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first-line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either nonsteriodal anti-inflammatory drugs (29%) or acetaminophen (16%). Thirty-five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.CONCLUSIONS: Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One-half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.

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