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Pain in Cancer Survivors: How to Manage

  • Palliative and Supportive Care (MP Davis, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Managing pain in cancer survivors requires that oncologists understand the common painful syndromes that can occur from treatment or disease. Assessment no longer singularly focuses on pain characteristics (e.g., intensity, quality, location), now incorporating a strong focus on functional impairment and potential improvement that might occur with adequate treatment. Improvement in function is now the goal used to measure success. In addition, assessment must incorporate risk factors that might predispose patients to substance use disorder so that interventions can be implemented to mitigate this risk. Universal precautions are measures that help assess and ensure adherence to the treatment plan and may include the use of agreements, urine toxicology, and review of dispensing information derived from state prescription drug monitoring program (PDMP). These are generally obtained annually for all individuals, although some states have instituted mandatory review of the PDMP whenever prescribing an opioid. For patients at moderate to high risk for misuse of opioids, where opioids are warranted for the treatment of their pain syndrome, universal precautions are instituted more frequently. Other measures may include prescribing a 1- to 2-week supply of medications if compulsive use leads the patient to running out of drug early, and in some cases, family members may be employed to dispense daily allotments of the medication. When opioids are no longer indicated, gradual tapering of the drug by approximately 10% per month is generally sufficient to prevent withdrawal symptoms and ensure patient acceptance.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(27):3325–45. Clinical practice guideline based upon systematic literature review and expert opinion; currently, the only guideline that specifically addresses this population.

    Article  Google Scholar 

  2. Paice JA. Cancer pain management and the opioid crisis in America: how to preserve hard-earned gains in improving the quality of cancer pain management. Cancer. 2018;124(12):2491–7.

    Article  Google Scholar 

  3. Paice JA. Under pressure: the tension between access and abuse of opioids in cancer pain management. J Oncol Pract. 2017;13(9):595–6.

    Article  Google Scholar 

  4. Denlinger CS, Carlson RW, Are M, Baker KS, Davis E, Edge SB, et al. Survivorship: introduction and definition. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2014;12(1):34–45.

    Article  Google Scholar 

  5. Moser EC, Meunier F. Cancer survivorship: a positive side-effect of more successful cancer treatment. EJC Suppl. 2014;12(1):1–4.

    Article  Google Scholar 

  6. •• Shapiro CL. Cancer survivorship. N Engl J Med. 2018;379(25):2438–50. Comprehensive, scholarly review of challenges faced by cancer survivors.

    Article  Google Scholar 

  7. Jensen MP, Chang HY, Lai YH, Syrjala KL, Fann JR, Gralow JR. Pain in long-term breast cancer survivors: frequency, severity, and impact. Pain Med. 2010;11(7):1099–106.

    Article  Google Scholar 

  8. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.

    Article  Google Scholar 

  9. • van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070–90 e9. Large systematic review and meta-analysis revealing significant prevalence of pain in those who have been treated for cancer.

    Article  Google Scholar 

  10. Davidsen M, Kjoller M, Helweg-Larsen K. The Danish National Cohort Study (DANCOS). Scand J Public Health. 2011;39(7 Suppl):131–5.

    Article  Google Scholar 

  11. Pachman DR, Barton DL, Swetz KM, Loprinzi CL. Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol. 2012;30(30):3687–96.

    Article  Google Scholar 

  12. Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2011;117(9):1994–2003.

    Article  Google Scholar 

  13. Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. Br J Anaesth. 2017;119(4):723–36.

    Article  CAS  Google Scholar 

  14. Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018;167(1):157–69.

    Article  Google Scholar 

  15. Huang IC, Hudson MM, Robison LL, Krull KR. Differential impact of symptom prevalence and chronic conditions on quality of life in cancer survivors and non-cancer individuals: a population study. Cancer Epidemiol Biomark Prev. 2017;26(7):1124–32.

    Article  Google Scholar 

  16. Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2017.

  17. Baxi S, Yang A, Gennarelli RL, Khan N, Wang Z, Boyce L, et al. Immune-related adverse events for anti-PD-1 and anti-PD-L1 drugs: systematic review and meta-analysis. BMJ. 2018;360:k793.

    Article  Google Scholar 

  18. Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, Caterino JM, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018;36(17):1714–68.

    Article  CAS  Google Scholar 

  19. Cappelli LC, Gutierrez AK, Bingham CO 3rd, Shah AA. Rheumatic and musculoskeletal immune-related adverse events due to immune checkpoint inhibitors: a systematic review of the literature. Arthritis Care Res. 2017;69(11):1751–63.

    Article  Google Scholar 

  20. Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, et al. Pain in cancer survivors. J Clin Oncol. 2014;32(16):1739–47.

    Article  CAS  Google Scholar 

  21. Cramer JD, Johnson JT, Nilsen ML. Pain in head and neck cancer survivors: prevalence, predictors, and quality-of-life impact. Otolaryngol Head Neck Surg. 2018;159(5):853–8.

    Article  Google Scholar 

  22. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25(7):1029–36.

    Article  Google Scholar 

  23. Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014;32(18):1941–67.

    Article  CAS  Google Scholar 

  24. Delanian S, Lefaix JL, Pradat PF. Radiation-induced neuropathy in cancer survivors. Radiother Oncol. 2012;105(3):273–82.

    Article  Google Scholar 

  25. Kim YJ, Dev R, Reddy A, Hui D, Tanco K, Park M, et al. Association between tobacco use, symptom expression, and alcohol and illicit drug use in advanced cancer patients. J Pain Symptom Manag. 2016;51(4):762–8.

    Article  Google Scholar 

  26. Kwon JH, Tanco K, Park JC, Wong A, Seo L, Liu D, et al. Frequency, predictors, and medical record documentation of chemical coping among advanced cancer patients. Oncologist. 2015;20(6):692–7.

    Article  CAS  Google Scholar 

  27. Barclay JS, Owens JE, Blackhall LJ. Screening for substance abuse risk in cancer patients using the Opioid Risk Tool and urine drug screen. Support Care Cancer. 2014;22(7):1883–8.

    Article  Google Scholar 

  28. Koyyalagunta D, Bruera E, Aigner C, Nusrat H, Driver L, Novy D. Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Med. 2013;14(5):667–75.

    Article  Google Scholar 

  29. Anghelescu DL, Ehrentraut JH, Faughnan LG. Opioid misuse and abuse: risk assessment and management in patients with cancer pain. J Natl Compr Cancer Netw. 2013;11(8):1023–31.

    Article  CAS  Google Scholar 

  30. Mathur VA, Richeson JA, Paice JA, Muzyka M, Chiao JY. Racial bias in pain perception and response: experimental examination of automatic and deliberate processes. J Pain. 2014;15(5):476–84.

    Article  Google Scholar 

  31. • Christo PJ, Manchikanti L, Ruan X, Bottros M, Hansen H, Solanki DR, et al. Urine drug testing in chronic pain. Pain Physician. 2011;14(2):123–43. Thorough guide to interpretation of urine toxicology.

    PubMed  Google Scholar 

  32. Peppin JF, Passik SD, Couto JE, Fine PG, Christo PJ, Argoff C, et al. Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain. Pain Med. 2012;13(7):886–96.

    Article  Google Scholar 

  33. Rauenzahn S, Sima A, Cassel B, Noreika D, Gomez TH, Ryan L, et al. Urine drug screen findings among ambulatory oncology patients in a supportive care clinic. Support Care Cancer. 2017;25(6):1859–64.

    Article  Google Scholar 

  34. Pergolizzi JV, Curro FA, Col N, Ghods MP, Vena D, Taylor R, et al. A multicentre evaluation of an opioid patient-provider agreement. Postgrad Med J. 2017;93(1104):613–7.

    Article  Google Scholar 

  35. Gugelmann HM, Perrone J. Can prescription drug monitoring programs help limit opioid abuse? JAMA. 2011;306(20):2258–9.

    Article  CAS  Google Scholar 

  36. Wen H, Schackman BR, Aden B, Bao Y. States with prescription drug monitoring mandates saw a reduction in opioids prescribed to medicaid enrollees. Health Aff (Millwood). 2017;36(4):733–41.

    Article  Google Scholar 

  37. de la Cruz M, Reddy A, Balankari V, Epner M, Frisbee-Hume S, Wu J, et al. The impact of an educational program on patient practices for safe use, storage, and disposal of opioids at a comprehensive cancer center. Oncologist. 2017;22(1):115–21.

    Article  Google Scholar 

  38. Reddy A, de la Cruz M, Rodriguez EM, Thames J, Wu J, Chisholm G, et al. Patterns of storage, use, and disposal of opioids among cancer outpatients. Oncologist. 2014;19(7):780–5.

    Article  Google Scholar 

  39. Pardo B. Do more robust prescription drug monitoring programs reduce prescription opioid overdose? Addiction. 2017;112(10):1773–83.

    Article  Google Scholar 

  40. Birthi P, Nagar VR, Nickerson R, Sloan PA. Hypogonadism associated with long-term opioid therapy: A systematic review. J Opioid Manag. 2015;11(3):255–78.

    Article  Google Scholar 

  41. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–61.

    PubMed  Google Scholar 

  42. Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J. Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerations. Anesth Analg. 2015;120(6):1273–85.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 850, Chicago, IL, 60611, USA

    Judith A. Paice PhD, RN

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  1. Judith A. Paice PhD, RN
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Correspondence to Judith A. Paice PhD, RN.

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Paice, J.A. Pain in Cancer Survivors: How to Manage. Curr. Treat. Options in Oncol. 20, 48 (2019). https://doi.org/10.1007/s11864-019-0647-0

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