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Adult Cancer-Related Pain

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Abstract

Although prevalence estimates vary widely, pain is understood to be widespread among those with cancer, and, for many, such pain is undertreated. Cancer-related pain can be associated with a multitude of causes, courses, and treatments. World Health Organization (WHO) guidelines have helped reduce the burden of pain among those with cancer, with the WHO Cancer Pain Ladder providing a simple algorithm for pain treatment. Opioid treatment continues to be a mainstay of cancer-related pain, and modifications of the WHO Cancer Pain Ladder may be required when pain is severe. As with all pain, psychological factors play an important role in cancer-related pain, with emotional distress, cognitive coping strategies like catastrophizing, and pain-related behaviors shown as important predictors of pain severity. Because of this, psychological and behavioral treatments have shown effectiveness in reducing cancer pain burden. Barriers to effective pain management include psychological barriers, such as a fear of opioid addiction, social variables, such as discriminatory patterns of prescribing, or cultural variables, such as a cultural emphasis on stoicism in the face of pain. As cancer develops into its advanced stages, pain management may move to the forefront of patient care. Palliative care programs are among the most effective approaches to reducing the undertreatment of cancer-related pain and are proven to increase patient quality of life while reducing healthcare costs. Unfortunately, inaccurate perceptions among both patients and physicians of palliative care as being for patients without hope continue to persist. Perceptions of palliative care, however, are beginning to change and the future of cancer treatment will likely see a greater multi-disciplinary and multi-specialty focus on the treatment of pain. Innovations such as patient navigation will also likely result in increased pain management and reduced ethnic disparities.

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References

  • ACS. (2010). Cancer facts and figures 2010. Atlanta: American Cancer Society.

    Google Scholar 

  • Adler, B., Yarchoan, M., & Adler, J. R. (2011). Neurosurgical interventions for the control of chronic pain conditions. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Adler, N. E., & Page, A. E. (Eds.). (2007). Cancer care for the whole patient: Meeting psychosocial health needs. Washington: National Academies Press.

    Google Scholar 

  • Ahles, T. A., Blanchard, E. B., & Ruckdeschel, J. C. (1983). The multidimensional nature of cancer-related pain. Pain, 17(3), 277–288.

    Article  PubMed  CAS  Google Scholar 

  • Alimi, D., Rubino, C., Pichard-Léandri, E., Fermand-Brule, S., Dubremit-Lemaire, M. L. & Hill, C. (2003). Analgesic effect of auricular acupuncture for cancer pain: A randomized, blinded, controlled trial. Journal of Clinical Oncology, 21(22), 4120–4126.

    Article  PubMed  Google Scholar 

  • Andersen, B. L., Thornton, L. M., Shapiro, C. L., Farrar, W. B., Mundy, B. L., Yang, H. C., et al. (2010). Biobehavioral, immune, and health benefits following recurrence for psychological intervention participants. Clinical Cancer Research, 16(12), 3270–3278.

    Article  PubMed  Google Scholar 

  • Andersen, B. L., Yang, H. C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thornton, L. M., et al. (2008). Psychologic intervention improves survival for breast cancer patients: A randomized clinical trial. Cancer, 113(12), 3450–3458.

    Article  PubMed  Google Scholar 

  • Anderson, K. O., Richman, S. P., Hurley, J., Palos, G., Valero, V., Mendoz, T. R., et al. (2002). Cancer pain management among underserved minority outpatients: Perceived needs and barriers to optimal control. Cancer, 94(8), 2295–2304.

    Article  PubMed  Google Scholar 

  • Anderson, R., Saiers, J. H., Abram, S., & Schlicht, C. (2001). Accuracy in equianalgesic dosing: Conversion dilemmas. Journal of Pain and Symptom Management, 21(5), 397–406.

    Article  PubMed  CAS  Google Scholar 

  • Axelsson, B., Stellborn, P., & Ström, G. (2008). Analgesic effect of paracetamol on cancer related pain in concurrent strong opioid therapy. A prospective clinical study. Acta Oncologica, 47(5), 891–895.

    Article  PubMed  CAS  Google Scholar 

  • Backonja, M., Beydoun, A., Edwards, K. R., Schwartz, S. L., Fonseca, V., Hes, M., et al. (1998). Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: A randomized controlled trial. Journal of the American Medical Association, 280, 1831–1836.

    Article  PubMed  CAS  Google Scholar 

  • Backonja, M., & Glanzman, R. L. (2003). Gabapentin dosing for neuropathic pain: Evidence from randomized, placebo-controlled clinical trials. Clinical Therapeutics, 25, 81–104.

    Article  PubMed  CAS  Google Scholar 

  • Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokan, F. C., Sevill, J., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. Journal of the American Medical Association, 302(7), 741–749.

    Article  PubMed  CAS  Google Scholar 

  • Bandura, A. (1989). Human agency in social cognitive theory. The American Psychologist, 44, 1175–1184.

    Article  PubMed  CAS  Google Scholar 

  • Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.

    Google Scholar 

  • Bennett, M. (2011). Effectiveness of antiepileptic or antidepressant drugs when added to opioids for cancer pain: A systematic review. Palliative Medicine, 25(5), 553–559.

    Google Scholar 

  • Berdine, H. J., & Nesbit, S. A. (2006). Equianalgesic dosing of opioids. Journal of Pain & Palliative Care Pharmacotherapy, 20(4), 79–84.

    Article  Google Scholar 

  • Berger, A., Dukes, E., Mercadante, S., & Oster, G. (2006). Use of antiepileptics and tricyclic antidepressants in cancer patients with neuropathic pain. European Journal of Cancer Care, 15(2), 138–145.

    Article  PubMed  CAS  Google Scholar 

  • Bishop, S. R., & Warr, D. (2003). Coping, catastrophizing and chronic pain in breast cancer. Journal of Behavioral Medicine, 26(3), 265–281.

    Article  PubMed  Google Scholar 

  • Breitbart, W. S., Park, J., & Katz, A. M. (2010). Pain. In J. Holland (Ed.), Psycho-oncology (2nd ed., pp. 215–228). New York: Oxford University Press.

    Chapter  Google Scholar 

  • Brown, M., Crowe, A., & Cousins, S. (2011). Educating patients and caregivers about pain management: What clinicians need to know. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Bruera, E., Palmer, J. L., Bosnjak, S., Rico, M. A., Moyano, J., Sweaney, C., et al. (2004). Methadone versus morphine as a first-line strong opioid for cancer pain: A randomized, double blind study. Journal of Clinical Oncology, 1, 185–192.

    Google Scholar 

  • Bruera, E., & Sweeney, C. (2002). Methadone use in cancer patients with pain: A review. Journal of Palliative Medicine, 5, 127–138.

    Article  PubMed  Google Scholar 

  • Buck, R., & Morley, S. A. (2006). Daily process design study of attentional pain control strategies in the self-­management of cancer pain. European Journal of Pain, 10(5), 385–398.

    Article  PubMed  Google Scholar 

  • Burton, A. W., Fanciullo, G. J., Beasley, R. D., & Fisch, M. J. (2007). Chronic pain in the cancer survivor: A new frontier. Pain Medicine, 8(2), 189–198.

    Article  PubMed  Google Scholar 

  • Bush, S., & Bruera, E. (2009). The assessment and management of delirium in cancer patients. The Oncologist, 14(10), 1039–1049.

    Article  PubMed  Google Scholar 

  • Carlsson, C. P., & Sjölund, B. H. (2001). Acupuncture for chronic low back pain: A randomized placebo-controlled study with long-term follow-up. The Clinical Journal of Pain, 17(4), 296–305.

    Article  PubMed  CAS  Google Scholar 

  • Cassileth, B., Trevisan, C., & Gubili, J. (2007). Complementary therapies for cancer pain. Current Pain and Headache Reports, 11(4), 265–269.

    Article  PubMed  Google Scholar 

  • Cassileth, B. R., & Keefe, F. J. (2010). Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain. The Oncologist, 15(Suppl 2), 19–23.

    Article  PubMed  Google Scholar 

  • Cassileth, B. R., & Vickers, A. J. (2004). Massage therapy for symptom control: Outcome study at a major cancer center. Journal of Pain and Symptom Management, 28(3), 244–249.

    Article  PubMed  Google Scholar 

  • CDC. (2004). Cancer survivorship-United States, 1971–2001. Morbidity and Mortality Weekly Report, 53(24), 526–529.

    Google Scholar 

  • Cervero, F., & Laird, J. M. (1999). Visceral pain. Lancet, 353(9170), 2145–2148.

    Article  PubMed  CAS  Google Scholar 

  • Chang, C.-H. (2011). Dynamic pain assessment: An application of clinical infometrics to personalized pain treatment and management. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Chen, M. L., Chang, H. K., & Yeh, C. H. (2000). Anxiety and depression in Taiwanese cancer patients with and without pain. Journal of Advanced Nursing, 32(4), 944–951.

    PubMed  CAS  Google Scholar 

  • Cherney, N. I. (2007). Cancer pain: Principles of assessment and syndromes. In A. M. Berger, J. L. Shuster Jr., & J. H. Von Roenn (Eds.), Principles and practice of palliative care and supportive oncology (3rd ed., pp. 3–26). Philadelphia: Lippincott, Williams & Wilkins.

    Google Scholar 

  • Cherny, N. (2000). New strategies in opioid therapy for cancer pain. The Journal of Oncology Management, 9(1), 8–15.

    PubMed  CAS  Google Scholar 

  • Chou, R., Fanciullor, G. J., & Fine, P. G. (2009). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain, 10(2), 113–130.

    Article  PubMed  CAS  Google Scholar 

  • Cleeland, C. (1998). Undertreatment of cancer pain in elderly patients. Journal of the American Medical Association, 279, 1914–1915.

    Article  PubMed  CAS  Google Scholar 

  • Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. The New England Journal of Medicine, 330(9), 592–596.

    Article  PubMed  CAS  Google Scholar 

  • Connor, S. R., Pyenson, B., Fitch, K., Spence, C., & Iwasaki, K. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Journal of Pain and Symptom Management, 33, 238–246.

    Article  PubMed  Google Scholar 

  • Corbin, L. (2005). Safety and efficacy of massage therapy for patients with cancer. Cancer Control, 12(3), 158–164.

    PubMed  Google Scholar 

  • Dallocchio, C., Buffa, C., Mazzarello, P., & Chiroli, S. (2000). Gabapentin vs. amitriptyline in painful diabetic neuropathy: An open-label pilot study. Journal of Pain and Symptom Management, 20, 280–285.

    Article  PubMed  CAS  Google Scholar 

  • Davis, M., Glare, P., & Hardy, J. (2005). Opioids in cancer pain. Oxford: Oxford University Press.

    Google Scholar 

  • Davis, M. P., Weissman, D. E., & Arnold, R. M. (2004). Opioid dose titration for severe cancer pain: A systematic evidence-based review. Journal of Palliative Medicine, 7, 462–468.

    Article  PubMed  Google Scholar 

  • Deandrea, S., Montanari, M., Moja, L., & Apolone, G. (2008). Prevalence of undertreatment in cancer pain. A review of published literature. Annals of Oncology, 19(12), 1985–1991.

    Article  PubMed  CAS  Google Scholar 

  • Deshields, T. L., Tait, R. C., Manwaring, J., Trinkaus, K. M., Naughton, M., Hawkins, J., et al. (2010). The Cancer Pain Inventory: Preliminary development and validation. Psycho-Oncology, 19(7), 684–692.

    Article  PubMed  Google Scholar 

  • Donovan, K. A., Thompson, L. M. A., & Jacobsen, P. B. (2011). Pain, depression and anxiety in cancer. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Dy, S., & Seow, H. (2011). Quality indicators for pain in palliative care. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Ehde, D. M., & Jensen, M. P. (2004). Feasibility of a cognitive restructuring intervention for treatment of chronic pain in persons with disabilities. Rehabilitation Psychology, 49, 254–258.

    Article  Google Scholar 

  • Eisenberg, E., Berkey, C. S., Carr, D. B., Mosteller, F., & Chalmers, T. C. (1994). Efficacy and safety of nonsteroidal anti inflammatory drugs for cancer pain: A meta-analysis. Journal of Clinical Oncology, 12(12), 2756–2765.

    PubMed  CAS  Google Scholar 

  • Fadul, N., Elsayem, A., Palmer, J. L., Del Fabbco, E., Swint, K., Li, E., et al. (2009). Supportive versus palliative care: What’s in a name? A survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer, 115(9), 2013–2021.

    Article  PubMed  Google Scholar 

  • Fairchild, A. (2010). Under-treatment of cancer pain. Current Opinion in Supportive and Palliative Care, 4(1), 11–15.

    Article  PubMed  Google Scholar 

  • Fine, P. (2011). Recognition and resolution of ethical barriers to palliative care research. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Fischer, D. J., Villines, D., Kim, Y. O., Epstein, J. B., & Wilkie, D. J. (2010). Anxiety, depression, and pain: Differences by primary cancer. Supportive Care in Cancer, 18(7), 801–810.

    Article  PubMed  Google Scholar 

  • Foro Arnalot, P., Fontanals, A. V., Galcerán, J. C., Lynd, F., Latiesas, Xs., de Dios, N. R., et al. (2008). Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30 Gy in 10 fractions compared with 8 Gy in single fraction. Radiotherapy and Oncology, 89, 150–155.

    Article  PubMed  Google Scholar 

  • Gatchel, R. J., Haggard, R., Thomas, C., & Howard, K. J. (2011). A biopsychosocial approach to understanding chronic pain and disability. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Goudas, L. C. (2005). The epidemiology of cancer pain. Cancer Investigation, 23, 182–190.

    Article  PubMed  Google Scholar 

  • Green, C. (2011). Disparities in pain management and palliative care. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Green, E., Zwaal, C., Beals, C., Fitzgerald, B., Harle, I., Jores, J., et al. (2010). Cancer-related pain management: A report of evidence-based recommendations to guide practice. The Clinical Journal of Pain, 26(6), 449–462.

    Article  PubMed  Google Scholar 

  • Hallenbeck, J. (2011). Pain and intercultural communication. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Hanks, G. W., Conno, F., Cherny, N., Hanna, M., Kalso, E., McQuay, H. J., et al. (2001). Morphine and alternative opioids in cancer pain: The EAPC recommendations. British Journal of Cancer, 84(5), 587–593.

    Article  PubMed  CAS  Google Scholar 

  • Haugen, D. F., Hjermstad, M. J., Hagen, N., Caraceni, A., Kaasa, S., & European Palliative Care Research Collaborative (EPCRC). (2010). Assessment and classification of cancer breakthrough pain: A systematic literature review. Pain, 149(3), 476–482.

    Article  PubMed  Google Scholar 

  • Haynes, M. A., Smedley, B. D., & Institute of Medicine, Committee on Cancer Research among Minorities and the Medically Underserved. (1999). The unequal burden of cancer: An assessment of NIH research and programs for ethnic minorities and the medically underserved. Washington: National Academy Press.

    Google Scholar 

  • Hempenstall, K., & Rice, A. S. (2002). Current treatment options in neuropathic pain. Current Opinion in Investigational Drugs, 3(3), 441–448.

    PubMed  CAS  Google Scholar 

  • Hewitt, M., Greenfield, S., & Stovall, E. (Eds.). (2005). From cancer patient to cancer survivor: Lost in transition: An Institute of Medicine and National Research Council Symposium. Washington: National Academies Press.

    Google Scholar 

  • Higginson, I. J., & Evans, C. J. (2010). What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer Journal, 16(5), 423–435.

    Article  Google Scholar 

  • Hiraga, K., Mizuguchi, T., & Takeda, F. (1991). The incidence of cancer pain and improvement of pain management in Japan. Postgraduate Medical Journal, 67(Suppl 2), S14–S25.

    PubMed  Google Scholar 

  • Hjermstad, M., Haugen, D. F., Bennett, M. I., & Kaasa, S. (2011). Pain assessment tools in palliative care and cancer. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Hopkins Hollis, A. S. (2010). Acupuncture as a treatment modality for the management of cancer pain: The state of the science. Oncology Nursing Forum, 37(5), E344–E348.

    Article  PubMed  Google Scholar 

  • Im, E. O., Guevara, E., & Chee, W. (2007). The pain experience of Hispanic patients with cancer in the United States. Oncology Nursing Forum, 34(4), 861–868.

    Article  PubMed  Google Scholar 

  • Im, E. O., Lim, H. J., Clark, M., & Chee, W. (2008a). African American cancer patients’ pain experience. Cancer Nursing, 31(1), 38–46.

    Article  PubMed  Google Scholar 

  • Im, E. O., Liu, Y., Kim, Y. H., & Chee, W. (2008b). Asian American cancer patients’ pain experience. Cancer Nursing, 31(3), E17–E23.

    Article  PubMed  Google Scholar 

  • Israel, F. J., Parker, G., Charles, M., & Reymond, L. (2010). Lack of benefit from paracetamol (acetaminophen) for palliative cancer patients requiring high-dose strong opioids: A randomized, double-blind, placebo-controlled, crossover trial. Journal of Pain and Symptom Management, 39(3), 548–554.

    Article  PubMed  CAS  Google Scholar 

  • Jacobsen, P. B., & Butler, R. W. (1996). Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. Journal of Behavioral Medicine, 19(1), 17–29.

    Article  PubMed  CAS  Google Scholar 

  • Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., Thun, J., et al. (2007). Cancer statistics, 2007. CA: A Cancer Journal for Clinicians, 57, 43–66.

    Article  Google Scholar 

  • Jensen, T. S., Madsen, C. S., & Finnerup, N. B. (2009). Pharmacology and treatment of neuropathic pains. Current Opinion in Neurology, 22(5), 467–474.

    Article  PubMed  CAS  Google Scholar 

  • Jenson, T. S., & Hansson, P. T. (2006). Classification of neuropathic pain syndromes based on symptoms and signs. Handbook of Clinical Neurology, 81, 517–526.

    Article  Google Scholar 

  • Jones, A. B., & Meier, D. E. (2011). How health care reform can improve access to quality pain and palliative care services. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Jost, L., & Roila, F. (2009). On behalf of the ESMO Guidelines Working Group. Management of cancer pain: ESMO clinical recommendations. Annals of Oncology, 20(Suppl 4), 170–173.

    Google Scholar 

  • Kagawa-Singer, M., Dadia, A. V., Yu, M. C., & Surbone, A. (2010). Cancer, culture, and health disparities: Time to chart a new course? CA: A Cancer Journal for Clinicians, 60(1), 12–39.

    Article  Google Scholar 

  • Kaley, T. J., & Deangelis, L. M. (2009). Therapy of chemotherapy-induced peripheral neuropathy. British Journal of Haematology, 145, 3–14.

    Article  PubMed  CAS  Google Scholar 

  • Keefe, F. J., Abernethy, A. P., & Campbell, L. C. (2005). Psychological approaches to understanding and treating disease-related pain. Annual Review of Psychology, 56, 601–630.

    Article  PubMed  Google Scholar 

  • Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: Current state of the science. The Journal of Pain, 5(4), 195–211.

    Article  PubMed  Google Scholar 

  • Kelley, A. S., & Meier, D. E. (2010). Palliative care – A shifting paradigm. The New England Journal of Medicine, 363, 781–782.

    Article  PubMed  CAS  Google Scholar 

  • Kelsen, D. P., Portenoy, R. K., Thaler, H. T., Niedzwiecki, D., Passik, S. D., Tao, Y., Banks, W., Brennan, M. F., & Foley, K. M. (1995). Pain and depression in patients with newly diagnosed pancreas cancer. Journal of Clinical Oncology, 13(3), 748–755.

    PubMed  CAS  Google Scholar 

  • Khan, A. A., Sándor, G. K., Dore, E., et al. (2008). Canadian consensus practice guidelines for biphosphonate associated osteonecrosis of the jaw. The Journal of Rheumatology, 35, 1391–1397.

    Google Scholar 

  • Khan, R. S., Ahmed, K., Blakeway, E., et al. (2011). Catastrophizing: A predictive factor of postoperative pain. The American Journal of Surgery, 201(1), 122–131.

    Article  Google Scholar 

  • Kottschade, L. A., Sloan, J. A., Mazurczak, M. A., Johnson, D. B., Murphy, E. P., et al. (2011). The use of vitamin E for the prevention of chemotherapy-induced peripheral neuropathy: Results of a randomized phase III clinical trial. Support Care Cancer, 19(11), 1769–1777.

    Google Scholar 

  • Kovach, C. R. (2011). Assessing pain and unmet needs in patients with advanced dementia: The role of the serial trial intervention (STI). In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Krantz, M. J., Martin, J., Stimmel, B., Mehta, D., & Haigney, M. C. (2009). QTc interval screening in methadone treatment. Annals of Internal Medicine, 150(6), 387–395.

    Article  PubMed  Google Scholar 

  • Kreps, G. (2011). Communication and palliative care: E-health interventions and pain management. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J., & Tu, W. (2010). Effect of telecare management on pain and depression in patients with cancer: A randomized trial. Journal of the American Medical Association, 304(2), 163–171.

    Article  PubMed  CAS  Google Scholar 

  • Kutner, J. S., & Smith, M. C. (2011). CAM in chronic pain and palliative care. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Kwekkeboom, K. L., Abbott-Anderson, K., & Wanta, B. (2010). Feasibility of a patient-controlled cognitive-­behavioral intervention for pain, fatigue, and sleep disturbance in cancer. Oncology Nursing Forum, 37(3), E151–E159.

    Article  PubMed  Google Scholar 

  • Laird, B. J., Boyd, A. C., Colvin, L. A., & Fallon, M. T. (2009). Are cancer pain and depression interdependent? A systematic review. Psycho-Oncology, 18(5), 459–464.

    Article  PubMed  Google Scholar 

  • Lawson, K., Reesor, K. A., Keefe, F. J., & Turner, J. A. (1990). Dimensions of pain-related cognitive coping: Cross validation of the factor structure of the Coping Strategies Questionnaire. Pain, 42, 195–204.

    Article  Google Scholar 

  • Lazarus, A., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

    Google Scholar 

  • Lee, W. M. (2010). The case for limiting acetaminophen-related deaths: Smaller doses and unbundling the opioid-acetaminophen compounds. Clinical Pharmacology and Therapeutics, 88(3), 289–292.

    Article  PubMed  CAS  Google Scholar 

  • Lenhard, R. E., Osteen, R. T., & Gansler, T. S. (2001). Clinical oncology. Atlanta: Wiley-Blackwell.

    Google Scholar 

  • Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology, 25(3), 282–291.

    Article  PubMed  Google Scholar 

  • Lossignol, D. A., & Dumitrescu, C. (2010). Breakthrough pain: Progress in management. Current Opinion in Oncology, 22(4), 302–306.

    Article  PubMed  Google Scholar 

  • Maly, R. C., Umezawa, Y., Ratliff, C. T., & Leake, B. (2006). Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Cancer, 106(4), 957–965.

    Article  PubMed  Google Scholar 

  • Mandalà, M., Moro, C., Labianca, R., Cremonesi, M., & Barni, S. (2006). Optimizing use of opiates in the management of cancer pain. Therapeutics and Clinical Risk Management, 2(4), 447–453.

    Article  PubMed  Google Scholar 

  • Mannino, R., Coyne, P., Swainey, C., Hansen, L. A., & Lyckholm, L. (2006). Methadone for cancer-related neuropathic pain: A review of the literature. Journal of Opioid Management, 2(5), 269–276.

    PubMed  Google Scholar 

  • Marinangeli, F., Ciccozzi, A., Leonardis, M., Aloisio, L., Mazzer, A., Paladin, A., et al. (2004). Use of strong opioids in advanced cancer pain: A randomized trial. Journal of Pain and Symptom Management, 27(5), 409–416.

    Article  PubMed  CAS  Google Scholar 

  • Markman, J. D. (2010). Bundle up: It’s painful out there – The case for opioid–acetaminophen combinations. Clinical Pharmacology & Therapeutics, 88(3), 292–294.

    Article  CAS  Google Scholar 

  • Mazanec, P. M., Daly, B. J., & Townsend, A. (2010). Hospice utilization and end-of-life care decision making of African Americans. The American Journal of Hospice & Palliative Care, 27(8), 560–566.

    Article  Google Scholar 

  • Mercadante, S., Casnccio, A., Fulfaro, F., Groff, L., Boff, R., Viltari, P., et al. (2001). Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: A prospective study. Journal of Clinical Oncology, 19, 2898–2904.

    PubMed  CAS  Google Scholar 

  • Mercadante, S., Porzio, G., Ferrera, P., Fulfaro, F., Aielli, F., Verna, L., et al. (2008). Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. European Journal of Pain, 12(8), 1040–1046.

    Article  PubMed  CAS  Google Scholar 

  • Meredith, P. J., Strong, J., & Feeney, A. (2006). Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain, 123(1–2), 146–154.

    Article  PubMed  Google Scholar 

  • Merluzzi, T. V., & Martinez Sanchez, M. A. (1997). Perceptions of coping behaviors by persons with cancer and health providers. Psycho-Oncology, 6(3), 197–203.

    Article  PubMed  CAS  Google Scholar 

  • Merluzzi, T. V., Nairn, R. C., Hedge, K., Martinez Sanchez, M. A., & Dunn, L. (2001). Self-efficacy for coping with cancer: Revision of the Cancer Behavior Inventory (version 2.0). Psycho-Oncology, 10(3), 206–217.

    Article  PubMed  CAS  Google Scholar 

  • Meuser, T., Pietruck, C., Radbruch, L., Stute, P., Lehmann, K. A., Grond, S., et al. (2001). Symptoms during cancer pain treatment following WHO-guidelines: A longitudinal follow-up study of symptom prevalence, severity and etiology. Pain, 93(3), 247–257.

    Article  PubMed  CAS  Google Scholar 

  • Mhaskar, R., Redzepovic, J., Wheatley, K., Clark, O. A., Miladinovic, B., Glasmaches, A., et al. (2010). Biphosphonates in multiple myeloma. Cochrane Database of Systematic Reviews, 3, CD003188.

    Google Scholar 

  • Miguel, R. (2000). Interventional treatment of cancer pain: The fourth step in the World Health Organization analgesic ladder? Cancer Control, 7, 149–156.

    PubMed  CAS  Google Scholar 

  • Mitra, S. (2008). Opioid-induced hyperalgesia: Pathophysiology and clinical implications. Journal of Opioid Management, 4(3), 123–130.

    PubMed  Google Scholar 

  • Morello, C. M., Leckband, S. G., Stoner, C. P., Moorhouse, D. F., & Saragian, G. A. (1999). Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Archives of Internal Medicine, 159, 1931–1937.

    Article  PubMed  CAS  Google Scholar 

  • Morris, D. B. (2011). Narrative and pain: Towards an integrative model. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Morrison, R. S., Wallenstein, S., Natale, D. K., Senzel, R. S., Huavg, L. L. (2000). “We don’t carry that” – failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. The New England Journal of Medicine, 342, 1023–1026.

    Article  PubMed  CAS  Google Scholar 

  • Morss, S. (2010). Evidence-based approaches to pain in advanced cancer. Cancer Journal, 16, 500–506.

    Article  Google Scholar 

  • Moryl, N., Coyle, N., Essandoh, S., & Glare, P. (2010). Chronic pain management in cancer survivors. Journal of the National Comprehensive Cancer Network, 8(9), 1104–1110.

    PubMed  Google Scholar 

  • Myers, J., Chan, V., Jarvis, V., & Walter-Dilks, C. (2010). Intraspinal techniques for pain management in cancer patients: A systematic review. Supportive Care in Cancer, 18, 137–149.

    Article  PubMed  Google Scholar 

  • National Center for Complementary and Alternative Medicine. (2010). CAM basics. http://nccam.nih.gov/health/whatiscam/D347.pdf. Accessed on Oct 14, 2010.

  • National Comprehensive Cancer Network. (2009). NCCN clinical practice guidelines in oncology-adult cancer pain. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed on Oct 14, 2010.

  • National Comprehensive Cancer Network. (2010). Adult Cancer Pain, v.1.2010. www.nccn.org. Accessed on Oct 14, 2010.

  • Ngo Su-mien, L., Gillianne, L., Yi, G., & Penson, R. T. (2011). Hope in the context of pain and palliative care. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Nicholson, A. B. (2007). Methadone for cancer pain. Cochrane Database of Systematic Reviews, (4), CD003971.

    Google Scholar 

  • Nilsson, U., Unosson, M., & Rawal, N. (2005). Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial. European Journal of Anaesthesiology, 22(2), 96–102.

    Article  PubMed  CAS  Google Scholar 

  • O’Connor, A. B., & Dworkin, R. H. (2009). Treatment of neuropathic pain: An overview of recent guidelines. The American Journal of Medicine, 122, S22–S32.

    Article  PubMed  Google Scholar 

  • O’Mahony, S., Goulet, J. L., & Payne, R. (2010). Psychosocial distress in patients treated for cancer pain: A prospective observational study. Journal of Opioid Management, 6(3), 211–222.

    Article  PubMed  Google Scholar 

  • Oneschuk, D., & al-Shari, M. Z. (2003). The pattern of gabapentin use in a tertiary palliative care unit. Journal of Palliative Care, 19, 185–187.

    PubMed  Google Scholar 

  • Palermo, Y. (2011). The art of pain: The patient’s perspective of chronic pain. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Pappagallo, M., Shaiova, L., Perlov, E., & Knotkova, H. (2007). Difficult pain syndromes: Bone pain, visceral pain, neuropathic pain. In A. M. Berger, J. L. Shuster Jr., & J. H. Von Roenn (Eds.), Principles and practice of palliative care and supportive oncology (3rd ed., pp. 27–43). Philadelphia: Lippincott, Williams & Wilkins.

    Google Scholar 

  • Pargeon, K. L., & Hailey, B. J. (1999). Barriers to effective cancer pain management: A review of the literature. Journal of Pain and Symptom Management, 18, 358–368.

    Article  PubMed  CAS  Google Scholar 

  • Parson, H. A., de la Cruz, M., El Osta, B., Li, Z., Caldecon, B., Paliner, J. L., et al. (2010). Methadone initiation and rotation in the outpatient setting for patients with cancer pain. Cancer, 116(2), 520–528.

    Article  CAS  Google Scholar 

  • Passick, S. D., Olden, M., Kirsh, K. L., & Portenoy, R. K. (2007). Substance abuse issues in palliative care. In A. M. Berger, J. L. Shuster Jr., & J. H. Von Roenn (Eds.), Principles and practice of palliative care and supportive oncology (pp. 457–466). Philadelphia: Lippincott, Williams & Wilkins.

    Google Scholar 

  • Pavlakis, N., Schmidt, R. L., Stockler, M. R. (2005). Biphosphonates for breast cancer. Cochrane Database of Systematic Reviews, 3, CD003474.

    Google Scholar 

  • Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18(2), 189–193.

    Article  PubMed  Google Scholar 

  • Portenoy, R. K., & Lesage, P. (1999). Management of cancer pain. Lancet, 353(9165), 1695–1700.

    Article  PubMed  CAS  Google Scholar 

  • Portenoy, R. K., Payne, D., & Jacobsen, P. (1999). Breakthrough pain: Characteristics and impact in patients with cancer pain. Pain, 81(1–2), 129–134.

    Article  PubMed  CAS  Google Scholar 

  • Porter, L. S., Keefe, F. J., Garst, J., McBride, C. M., & Baucom, D. (2008). Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress. Pain, 137, 306–315.

    Article  PubMed  Google Scholar 

  • Queneau, P., Navez, M., Peyron, R., & Laurent, B. (2003). Introduction à la physiopathologie de la douleur. Applications aux douleurs viscérales. Gastroenterology & Clinical Biology, 27(3 Suppl), S59–S67.

    Google Scholar 

  • Quigley, C. (2005). The role of opioids in cancer pain. Journal of the American Medical Association, 331(7520), 825–829.

    Google Scholar 

  • Raffa, R. B. (2001). Pharmacology of oral combination analgesics: Rational therapy for pain. Journal of Clinical Pharmacy and Therapeutics, 26(4), 257–264.

    Article  PubMed  CAS  Google Scholar 

  • Reddick, B. K., Nanda, J. P., Campbell, L., Ryman, D. G., & Gaston-Johansson, F. (2005). Examining the influence of coping with pain on depression, anxiety and fatigue among women with breast cancer. Journal of Psychosocial Oncology, 23(2), 137–157.

    PubMed  Google Scholar 

  • Reddy, S., Hui, D., El Osta, B., de la Cruz, M., Walker, P., Palmer, J. L., et al. (2010). The effect of oral methadone on the QTc interval in advanced cancer patients: A prospective pilot study. Journal of Palliative Medicine, 13, 33–38.

    Article  PubMed  Google Scholar 

  • Regan, J. M., & Peng, P. (2000). Neurophysiology of cancer pain. Cancer Control, 7(2), 111–119.

    PubMed  CAS  Google Scholar 

  • Rice, A. S., Maton, S., & Postherpetic Neuralgia Study Group. (2001). Gabapentin in postherpetic neuralgia: A randomised, double blind, placebo controlled study. Pain, 94, 215–224.

    Article  PubMed  CAS  Google Scholar 

  • Rich, B. A. (2011). The delineation and explication of palliative options of last resort. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Ripamonti, C., Fagnoni, E., Campa, T., Brunelli, C., & DeConno, F. (2006). Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy. Supportive Care in Cancer, 14, 400–407.

    Article  PubMed  Google Scholar 

  • Ripamonti, C., Groff, L., Brunelli, C., Polastri, D., Stavrakis, A., de Conno, F., et al. (1998). Switching from morphine to oral methadone in treating cancer pain: What is the equianalgesic dose ratio? Journal of Clinical Oncology, 16, 3216–3221.

    PubMed  CAS  Google Scholar 

  • Ripamonti, C., Zecca, E., & Bruera, E. (1997). An update on the clinical use of methadone for cancer pain. Pain, 70, 109–115.

    Article  PubMed  CAS  Google Scholar 

  • Rowbotham, M., Harden, N., Stacey, B., Bernstein, P., & Magnus-Miller, L. (1998). Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial. Journal of the American Medical Association, 280, 1837–1842.

    Article  PubMed  CAS  Google Scholar 

  • Rust, G., Nembhard, W. N., Nichols, M., Omole, F., Minor, P., Barosso, G., & Mayberry, R. (2004). Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery. American Journal of Obstetrics and Gynecology, 191, 456–462.

    Article  PubMed  Google Scholar 

  • Schapira, L., & Steensma, D. (2011). Truth telling and palliative care. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Shaheen, P. E., Walsh, D., Lasheen, W., Davis, M. P., & Lagman, R. L. (2009). Opioid equianalgesic tables: Are they all equally dangerous? Journal of Pain and Symptom Management, 38(3), 409–417.

    Article  PubMed  Google Scholar 

  • Short, R., III, & Vetter, T. R. (2011). Acute to chronic pain: Transitions in the post surgical patient. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Smith, H. S., Datta, S., & Manchikanti, L. (2011). Evidence-based pharmacotherapy of chronic pain. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Spiegel, D., & Bloom, J. R. (1983). Pain in metastatic breast cancer. Cancer, 52(2), 341–345.

    Article  PubMed  CAS  Google Scholar 

  • Spiegel, D., Sands, S., & Koopman, C. (1994). Pain and depression in patients with cancer. Cancer, 74(9), 2570–2578.

    Article  PubMed  CAS  Google Scholar 

  • Stanton, A. L., Ganz, P. A., Rowland, J. H., Meyerowitz, B. E., Kruinick, J. L., Sears, S. R., et al. (2005). Promoting adjustment after treatment for cancer. Cancer, 104(11 Suppl), 2608–2613.

    Article  PubMed  Google Scholar 

  • Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Gallagher, E. R., Admine, S., Jackson, V. A., et al. (2001). Theoretical perspectives on the relation of between catastrophizing and pain. The Clinical Journal of Pain, 17(1), 52–64.

    Article  PubMed  CAS  Google Scholar 

  • Szucs-Reed, R. P., & Gallagher, R. M. (2011). Chronic pain and opioids. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

  • Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admine, S., Jackson, V. A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.

    Article  PubMed  CAS  Google Scholar 

  • Todd, K. H., Deaton, C., D’Adamo, A. P., & Goe, L. (2000). Ethnicity and analgesic practice. Annals of Emergency Medicine, 35(1), 11–16.

    Article  PubMed  CAS  Google Scholar 

  • Trescot, A. M., Boswell, M. V., Atluri, S. L., et al. (2006). Opioid guidelines in the management of chronic non-cancer pain. Pain Physician, 9(1), 1–39.

    PubMed  Google Scholar 

  • Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70(3), 678–690.

    Article  PubMed  Google Scholar 

  • Utne, I., Miaskowski, C., Bjordal, K., Paul, S. M., Jakobsen, G., & Rustøen, T. (2009). Differences in the use of pain coping strategies between oncology inpatients with mild vs. moderate to severe pain. Journal of Pain and Symptom Management, 38(5), 717–726.

    Article  PubMed  Google Scholar 

  • Van den Beuken-van Everdingen, M. H., de Rijke, J. M., Kessels, A. G., Schoten, H. C., Van Kleef, M., Patijn, J., et al. (2007). Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology, 18(9), 1437–1449.

    Article  PubMed  CAS  Google Scholar 

  • Velikova, G., Selby, P. J., Snaith, P. R., & Kirby, P. G. (1995). The relationship of cancer pain to anxiety. Psychotherapy and Psychosomatics, 63(3–4), 181–184.

    Article  PubMed  CAS  Google Scholar 

  • Ventafridda, V., Caraceni, A., Gamba, A. (1990). Field-testing of the WHO guidelines for cancer pain relief: Summary report of demonstration projects. In K. M. Foley, J. J. Bonica, V. Ventafridda (Eds.), Advances in pain research and therapy. Proceedings of the second international congress on pain (Vol. 16, pp. 451–464). New York: Raven Press.

    Google Scholar 

  • Von Roenn, J. H., Cleeland, C. S., Gonin, R., Hatfield, A. K., & Pandya, K. (1993). Physician attitudes and practice in cancer pain management: A survey from the Eastern Cooperative Oncology Group. Annals of Internal Medicine, 119(2), 121–126.

    Article  Google Scholar 

  • Weissman-Fogel, I., Sprecher, E., & Pud, D. (2008). Effects of catastrophizing on pain perception and pain modulation. Experimental Brain Research, 186(1), 79–85.

    Article  Google Scholar 

  • Wilkie, D. J., & Keefe, F. J. (1991). Coping strategies of patients with lung cancer-related pain. The Clinical Journal of Pain, 7(4), 292–299.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. (1987). Traitement de la douleur cancéreuse. Geneva: World Health Organization.

    Google Scholar 

  • Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10(1), 19–28.

    Article  PubMed  CAS  Google Scholar 

  • Zaza, C., & Baine, N. (2002). Cancer pain and psychosocial factors: A critical review of the literature. Journal of Pain and Symptom Management, 24(5), 526–542.

    Article  PubMed  Google Scholar 

  • Zech, D. F., Gron, S., Lynch, J., Hertel, D., & Lehmann, K. A. (1995). Validation of World Health Organization guidelines for cancer pain relief: A 10-year prospective study. Pain, 63(1), 65–76.

    Article  PubMed  CAS  Google Scholar 

  • Zhao, Z., & Cope, D. K. (2011). Nerve blocks, trigger points, and intrathecal therapy for chronic pain. In R. J. Moore (Ed.), Handbook of pain and palliative care: Biobehavioral approaches for the life course. New York: Springer.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA

    Sean Ransom PhD

  2. Tulane University Medical Center, Tulane Cancer Center, New Orleans, LA, USA

    Sean Ransom PhD

  3. Departments of Medical Social Sciences and Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Timothy P. Pearman PhD

  4. Department of Supportive Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

    Timothy P. Pearman PhD

  5. Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Errol Philip PhD

  6. Department of Medicine, Section of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, LA, USA

    Dominique Anwar MD

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    Rhonda J. Moore

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Ransom, S., Pearman, T.P., Philip, E., Anwar, D. (2013). Adult Cancer-Related Pain. In: Moore, R.J. (eds) Handbook of Pain and Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1651-8_17

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