Chronic Pain Management in Cancer Survivors

2010 ◽  
Vol 8 (9) ◽  
pp. 1104-1110 ◽  
Author(s):  
Natalie Moryl ◽  
Nessa Coyle ◽  
Samuel Essandoh ◽  
Paul Glare
Keyword(s):  
Pain Management ◽  
Cancer Survivors ◽  
Cancer Survivor ◽  
Behavioral Therapy ◽  
Management Plan ◽  
Opioid Therapy ◽  
Epidemiologic Studies ◽  
Concurrent Disorders ◽  
Neoplastic Process ◽  
Anticancer Treatment

The problem of pain in cancer survivors is attracting increased attention. Although comprehensive information about the prevalence of persistent pain in the cancer survivor population is currently lacking, it is known to depend on the type of cancer, comorbid conditions, and the initial pain management. Epidemiologic studies generally categorize pain in patients with cancer as either pain directly caused by the neoplastic process or related phenomena, pain occurring as a complication of anticancer treatment, or pain unrelated to the neoplastic process, caused by debility or concurrent disorders. This article focuses on pain syndromes in cancer survivors and the safe use of opioid therapy in this population when its ongoing use is part of the pain management plan. The use of physical therapy, rehabilitation therapy, and cognitive behavioral therapy, which are all extremely important aspects of pain management in the cancer survivor, are briefly mentioned.

Complementary therapies in pain management

2015 ◽  
Author(s):  
Gary Deng ◽  
Barrie R. Cassileth
Keyword(s):  
Pain Management ◽  
Music Therapy ◽  
Complementary Therapies ◽  
Emotional State ◽  
Belief System ◽  
Management Plan ◽  
Opioid Therapy ◽  
Analgesic Effects ◽  
Anxiety Depression ◽  
The Impact

Complementary therapies are modalities that are not traditionally part of Western medical care. Some of these therapies have demonstrated a favourable benefit:risk ratio in recent research and many can be incorporated into a multimodality pain management plan. In general, complementary therapies reduce pain by interfering with the processing of pain signals or lessen the impact of pain on the patient’s emotional state. Mind-body therapies, such as hypnosis, meditation, yoga/qigong, and music therapy, can reduce anxiety, depression, and stress-all common in patients experiencing pain. Acupuncture appears to have direct analgesic effects and reduce nausea and vomiting, which are potential side effects from opioid therapy. Massage therapy may reduce anxiety, and to a lesser degree, depression and pain. Complementary therapies are generally safe when provided by trained practitioners, although certain safety precautions still need to be exercised. The origin of pain, the factors complicating it, burdens and risks to patient, and each patient’s belief system and cultural background should all be considered when selecting from among the complementary modalities for pain.

Opioid safety among high-risk cancer survivors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19169-e19169
Author(s):  
Talya Salz ◽  
Akriti A. Mishra ◽  
Renee L. Gennarelli ◽  
Allison Lipitz-Snyderman ◽  
Denise Boudreau ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Survivors ◽  
Management Strategies ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Management Procedure ◽  
After Cancer ◽  
High Risk Cancer ◽  
First 90 Days

e19169 Background: To mitigate risks of opioid-related harms, ASCO’s pain management guidelines for cancer survivors recommend that opioids be used in conjunction with other pharmacologic and non-pharmacologic approaches. The guidelines also recommend caution when prescribing opioids and benzodiazepines concurrently. We evaluated these 2 metrics of safe prescribing as applied to chronic opioid therapy (COT) among older survivors of head and neck cancer (HNC) and lung cancer (LC), two growing populations with high pain burden and prevalent risk factors for opioid-related harms (e.g., opioid use during treatment, history of substance use, distress). Methods: Using SEER-Medicare, we identified opioid-naïve adults diagnosed 2008-2015 with HNC or LC. We restricted analyses to survivors with ≥1 COT episode (≥90 days) occurring ≥1 year after cancer diagnosis and ≤120 days prior to hospice entry or cancer-related death (survivorship period). We report 2 opioid safety metrics during the survivorship period: 1) the proportion of survivors with non-opioid pain management (≥1 dispensing for a non-opioid, non-benzodiazepine pain medication or ≥1 claim for pain management procedure) concurrent with the first 90 days of the first COT episode and 2) the proportion of survivors with 0 dispensings for benzodiazepines within the first 90 days of the first COT episode. Results: Among opioid-naïve HNC (N = 5,500) and LC (N = 21,090) patients, 306 HNC (5.6%) and 927 LC survivors (4.4%) received COT during follow-up. Median duration of first survivorship COT episode was 5.2 and 4.9 months for HNC and LC, respectively. 64% of HNC survivors received non-opioid pain management concurrent with their first COT episode; 55% received an analgesic and 24% underwent a procedure. 75% of LC survivors received non-opioid pain management concurrent with their first COT episode; 67% received an analgesic and 35% underwent a procedure. 79% of HNC and 81% of LC survivors did not receive benzodiazepines during the first COT episode. Conclusions: Among older survivors of LC and HNC, less than 6% receive COT. However, of those, one-half of HNC survivors and more than a third of LC survivors receive guideline-discordant care by using COT without other pain management strategies or while using benzodiazepines. To minimize opioid-related harms, efforts should focus on improving safe COT prescribing practices for survivors. [Table: see text]

scholarly journals Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

2021 ◽  
Author(s):  
Devon K Check ◽  
Christopher D Bagett ◽  
KyungSu Kim ◽  
Andrew W Roberts ◽  
Megan C Roberts ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Cancer Survivors ◽  
Low Income ◽  
Opioid Therapy ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

scholarly journals Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

Children ◽  
2018 ◽  
Vol 5 (12) ◽  
pp. 163
Author(s):  
Genevieve D’Souza ◽  
Anava A Wren ◽  
Christina Almgren ◽  
Alexandra C. Ross ◽  
Amanda Marshall ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Stress Responses ◽  
Physiological Stress ◽  
Opioid Therapy ◽  
Outpatient Basis ◽  
Opioid Use ◽  
Pediatric Populations ◽  
Special Expertise ◽  
Pain Symptoms

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

A smoking cessation and pain management program for cancer survivors

2018 ◽  
Vol 12 (6) ◽  
pp. 821-827 ◽  
Author(s):  
Kathryn I. Pollak ◽  
Laura J. Fish ◽  
Linda M. Sutton ◽  
Xiaomei Gao ◽  
Pauline Lyna ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Pain Management ◽  
Cancer Survivors ◽  
Management Program ◽  
Pain Management Program
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