New guidelines on treating cancer pain from the Spanish Society of Medical Oncology

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Takeaway

  • Cancer pain treatment should be tailored to patient's needs and the specific cause of the pain.

Why this matters

  • 1 study showed that up to 31% of patients with cancer have inadequately treated pain.
  • Several factors may contribute to inadequate pain management, such as poor pain assessment practices, fear of the adverse effects of opioids, and patient miscommunication.

Recommendations

  • Neuropathic pain is highly prevalent in pancreatic, primary bone, lung, and head and neck cancers, and 40% of cancer survivors present with pain.
  • Regular, self-reported assessment of pain intensity using a validated multidimensional assessment tool is necessary.
  • Nonopioids like paracetamol and NSAIDs have anti-inflammatory, analgesic, and antipyretic properties and are effective for mild or moderate pain.
  • For moderate pain, mild opioids like codeine, dihydrocodeine, and tramadol can be used, and can also be given in a combination with a nonopioid analgesic.
  • For severe pain, strong opioids like morphine, methadone, oxycodone, hydromorphone, fentanyl, and buprenorphine can be used in tittered dose to get maximum benefit and minimal toxicity.
  • Opioid rotation can be followed in patients experiencing pain often to avoid toxicity and obtain better analgesia.
  • Other treatment methods like interventional therapies, peripheral and autonomic nerve blocks, neuroaxial infusion, vertebroplasty/kyphoplasty, and radiation therapy can be used.

Coauthored with Anand Ramanathan, PharmD