NEW : Clinical Practice Guideline for Management of Chronic Pain in Survivors of Adult Cancers issued by ASCO, 2016
29 Jul 2016
To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors, an ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation.
A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus.
Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored.
Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function.
Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment.
Risks of adverse effects of opioids should be assessed.
Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences.
More information, including the 21 recommendations, a data supplement with additional evidence tables, a methodology supplement with information about evidence quality and strength of recommendations, slide sets, and clinical tools and resources, is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki. Patient information is available at www.cancer.net.
Reference : Judith A. Paice, Russell Portenoy, Christina Lacchetti et all. - Management of Chronic Pain in Survivors of Adult Cancers : American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34, 2016.