A breakthrough on chronic pain management in adult cancer survivors by ASCO
Today, a novel clinical practice guideline on management of chronic pain in adult cancer survivors was bought forward by the American Society of Clinical Oncology (ASCO). The main highlight is on the chronic pain among cancer survivors and deals exclusively with the pain that people experience after cancer treatment. For safe and effective treatment of persistent pain, the guideline endorse a full range of evidence-based strategies.
Presently, there are about 14 million cancer survivors in the United States due to the exceptional advances in cancer diagnosis and therapy. After the treatment, an estimated 40% of survivors still witness persistent pain which can be calamitous to their quality of life.
The ASCO’s recommendations encompasses both long-standing and new approaches like:
Regular screening for chronic pain,
Use of substitutes for pain management approaches like hypnosis and meditation,
Estimating the potential for opioid overuse and,
Employ medical cannabis in certain settings in states where it is legitimate
Judith A. Paice, PhD, RN, a co-chair of the ASCO Expert Panel that developed the guideline stated that " Many oncologists and primary care physicians are not trained to recognize or treat long-term pain associated with cancer.This guideline will help clinicians identify pain early and develop comprehensive treatment plans, using a broad range of approaches." These guidelines are formulated by a special multidisciplinary panel of specialists in hematology/oncology, hospice, medical oncology, pain medicine, palliative care, social work, radiation oncology, rehabilitation, anesthesiology and psychology as well as a patient representative. Also, this panel coordinated a systematic review of medical literature published from 1996 to 2015.
This is one of the only guidelines whose sole priority is on the growing population of cancer survivors with chronic pain although there are other guidelines that address the relief of pain because of advanced cancer as well as chronic pain in non-cancer situations. The description of a wide range of pain syndromes associated with cancer treatments is considered as an important part of this guideline.
The salient guideline recommendations are:
The clinicians should monitor for pain at each encounter with a patient. Proper evaluation, treatment and monitoring should be done for the recurrent disease, second malignancy or late onset treatment outcomes.
The clinicians may advise non-pharmacologic interventions like physical medicine and rehabilitation, integrative therapies (e.g., acupuncture and massage), interventional therapies and psychological approaches (e.g., guided imagery, hypnosis and meditation).
To ease the chronic pain and/or improve physical function, systematic non-opioid analgesics (acetaminophen, NSAIDs) and adjuvant analgesics (selected antidepressants and anticonvulsants), may be directed.
To decrease abuse, addiction and adverse consequences, clinicians should determine the risk of adverse effects of opioids used in pain management and thus subsume universal precautions.
The cancer patients who do not respond to more conservative pain management and who continue to undergo pain-related distress or impairment of physical function should be cautiously selected for prescribing a trial of opioids.
The clinicians may follow certain state regulations that allow permit to medical cannabis or cannabinoids for patients with chronic pain after considering the potential advantages and dis-advantages of the available formulations.
As per Dr. Paice "Of great importance is the attention to appropriate assessment, not only of the individual’s pain, but also of their potential for over-reliance on opioids. This guideline outlines precautions that help ensure cancer survivors with persistent pain use opioids safely and effectively, while limiting access to those who are struggling with addiction.”