Skip to main content

Pain Management in Older Cancer Patients

  • Living reference work entry
  • First Online:
Geriatric Oncology

Abstract

As a very frequent symptom, cancer pain in the elderly is an obvious signal for the need to improve the situation, both in physical terms and in terms of a more holistic approach. The multiplicity of causes and expressions of pain and the many means at our disposal for its management should not interfere with a rigorous diagnostic and therapeutic approach based on specific assessment and prognostic scales associated with a comprehensive geriatric evaluation. Thus, knowledge of the precise and safe handling of analgesics and other associated drug products, which can absolutely be offered to these vulnerable patients, is of paramount importance and must always be accompanied by a wish to combine this with consideration and multidisciplinary expertise while pursuing the objective of relief and the maintenance of a level of functional ability and quality of life that are acceptable to the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–46.

    Article  Google Scholar 

  • Amtmann D, Cook KF, Jensen MP, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2009 revision. Eur J Neurol. 2010. https://doi.org/10.1111/j.1468-1331.2010.02999.x.

  • Balducci L, Dolan D, Hoffe SA. Palliative care in older patients with cancer. Cancer Control. 2015;22(4):480–8.

    Article  PubMed  Google Scholar 

  • Bandieri E, Romero M, Ripamonti CI, et al. Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain. J Clin Oncol. 2016;34(5):436–42.

    Article  CAS  PubMed  Google Scholar 

  • Bannister K. Opioid-induced hyperalgesia: where are we now? Curr Opin Support Palliat Care. 2015;9(2):116–21.

    Article  PubMed  Google Scholar 

  • Barbera L, Molloy S, Earle CC. Frequency of non-cancer-related pain in patients with cancer. J Clin Oncol. 2013;31(22):2837.

    Article  PubMed  Google Scholar 

  • Bell RF, Eccleston C, Kalso EA. Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database Syst Rev. 2012;11:CD003351.

    PubMed  Google Scholar 

  • Boussahira D, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29–36.

    Article  Google Scholar 

  • Brasseur L, Larue F Bauchet A. Etude épidémiologique multicentrique (n=605) à 12 ans d’intervalle (1991–2002) Epidémiologie des douleurs du cancer en France, EFIC; 2006.

    Google Scholar 

  • Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.

    Article  CAS  PubMed  Google Scholar 

  • Bruera E, Belzile M, Pituskin E, et al. Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain. J Clin Oncol. 1998;16(10):3222–9.

    Article  CAS  PubMed  Google Scholar 

  • Bruera E, Kim HN. Cancer pain. JAMA. 2003;290(18):2476–9.

    Article  CAS  PubMed  Google Scholar 

  • Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method of the assessment of palliative care patients. J Palliat Care. 1991;7:6–9.

    CAS  PubMed  Google Scholar 

  • Buffum MD, Hutt E, Chang VT, et al. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev. 2007;44(2):315–30.

    Article  PubMed  Google Scholar 

  • Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13(2):e58–68.

    Article  CAS  PubMed  Google Scholar 

  • Chen CH, Tang ST, Chen CH. Meta-analysis of cultural differences in western and Asian patient-perceived barriers to managing cancer pain. Palliat Med. 2012;26(3):206–21.

    Article  PubMed  Google Scholar 

  • Clemens KE, Quednau I, Klaschik E. Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids? J Palliat Med. 2008;11(2):204–16.

    Article  PubMed  Google Scholar 

  • Dalal S, Hui D, Nguyen L, et al. Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center. Cancer. 2012;118(15):3869–77.

    Article  PubMed  Google Scholar 

  • Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, Kent JL, Krane EJ, Lebel AA, Levy RM, Mackey SC, Mayer J, Miaskowski C, Raja SN, Rice AS, Schmader KE, Stacey B, Stanos S, Treede RD, Turk DC, Walco GA, Wells CD. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3–14. Review

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sørbye L, Topinkova E, Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005 Sep;55(3):241–52.

    Article  PubMed  Google Scholar 

  • Fainsinger RL, Nekolaichuk CL. A “TNM” classification system for cancer pain: the Edmonton classification system for cancer pain (ECS-CP). Support Care Cancer. 2008;16(6):547–55.

    Article  PubMed  Google Scholar 

  • Falandry C, Filbet M, Magnet M, Trillet-Lenoir V, Bonnefoy M. Oncogériatrie: quelle réalité aujourd’hui ? Méd Palliat. 2011;10:223–9.

    Article  Google Scholar 

  • Fine PG, Portenoy RK. Ad hoc expert panel on evidence review and guidelines for opioid rotation: establishing “best practices” for opioid rotation: conclusions of an expert panel. J Pain Symptom Manag. 2009;38(3):418–25.

    Article  Google Scholar 

  • Fischer DJ, Villines D, Kim YO, et al. Anxiety, depression, and pain: differences by primary cancer. Support Care Cancer. 2010;18(7):801–10.

    Article  PubMed  Google Scholar 

  • Fuchs-Lacelle S, Hadjistavropoulos T. Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs. 2004;5(1):37–49.

    Article  PubMed  Google Scholar 

  • Green CR, Hart-Johnson T. Cancer pain: an age-based analysis. Pain Med. 2010;11(10):1525–36.

    Article  PubMed  Google Scholar 

  • Grond S, Zech D, Diefenbach C, et al. Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain. 1996;64(1):107–14.

    Article  CAS  PubMed  Google Scholar 

  • Gutgsell T, Walsh D, Zhukovsky DS, et al. A prospective study of the pathophysiology and clinical characteristics of pain in a palliative medicine population. Am J Hosp Palliat Care. 2003;20(2):140–8.

    Article  PubMed  Google Scholar 

  • Haywood A, Good P, Khan S, et al. Corticosteroids for the management of cancer-related pain in adults. Cochrane Database Syst Rev. 2015;4:CD010756.

    Google Scholar 

  • Hemett OM, Descombes E, Ionescu M, Blondel N, Hayoz D. Patients gériatriques insuffisants rénaux chroniques: quelle antalgie? Rev Med Suisse. 2014;10:804–10.

    PubMed  Google Scholar 

  • Herr K, Coyne PJ, Key T, Mc Caffery M, Manworren R, Merkel S, et al. Pain assessment in the patient unable to self report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12:230–1.

    Article  PubMed  Google Scholar 

  • Hølen JC, Lydersen S, Klepstad P, et al. The brief pain inventory: pain’s interference with functions is different in cancer pain compared with noncancer chronic pain. Clin J Pain. 2008;24(3):219–25.

    Article  PubMed  Google Scholar 

  • Hui D, Bruera E. A personalized approach to assessing and managing pain in patients with cancer. J Clin Oncol. 2014;32(16):1640–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hwang SS, Chang VT, Fairclough DL, et al. Development of a cancer pain prognostic scale. J Pain Symptom Manag. 2002;24(4):366–78.

    Article  Google Scholar 

  • Im EO, Lee SH, Liu Y, et al. A national online forum on ethnic differences in cancer pain experience. Nurs Res. 2009;58(2):86–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krakowski I, Baylot D, Chvetzoff G, Collin E, Coulouma R, Dixmerias F, Feuvret L, Freyssinet-Durand C, Lauwers-Allot E, Lossignol D, et al. Prise en charge de la douleur au cours des procédures invasives en cancérologie: efficacité et acceptabilité du mélange inhalé 50% N2O/O2 (MEOPA). Douleur et analgésie. 2010;23(2):113–20.

    Article  Google Scholar 

  • McLean S, Twomey F. Methods of rotation from another strong opioid to methadone for the management of cancer pain: a systematic review of the available evidence. J Pain Symptom Manag. 2015;50(2):248–59.e1.

    Article  Google Scholar 

  • Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;3(1):277–99.

    Article  Google Scholar 

  • Mercadante S, Aielli F, Masedu F, Valenti M, Ficorella C, Porzio G. Pain characteristics and analgesic treatment in an aged adult population: a 4-week retrospective analysis of advanced cancer patients followed at home. Drugs Aging. 2015;32(4):315–20.

    Article  CAS  PubMed  Google Scholar 

  • Morita T, Tei Y, Tsunoda J, et al. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain Symptom Manag. 2001;22(6):997–1006.

    Article  CAS  Google Scholar 

  • National Cancer Institute and National Institute of Aging (U.S.). Perspectives on prevention and treatment of cancer in the elderly. An Intern Med. 1984;100:332.

    Google Scholar 

  • Paulsen O, Klepstad P, Rosland JH, et al. Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol. 2014;32:3221.

    Article  CAS  PubMed  Google Scholar 

  • Pautex S1, Michon A, Guedira M, Emond H, Le Lous P, Samaras D, Michel JP, Herrmann F, Giannakopoulos P, Gold G. Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc. 2006 54(7):1040–1045.

    Google Scholar 

  • Potter VT, Wiseman CE, Dunn SM, et al. Patient barriers to optimal cancer pain control. Psychooncology. 2003;12(2):153–60.

    Article  PubMed  Google Scholar 

  • Rat P, Bonin Guillaume S, Pickering G, Leglise M-S. collectif Doloplus et coll., Douleur; 2014.

    Google Scholar 

  • Simon SM, Schwartzberg LS. A review of rapid-onset opioids for breakthrough pain in patients with cancer. J Opioid Manag. 2014;10(3):207–15.

    Article  PubMed  Google Scholar 

  • Syrjala KL, Jensen MP, Mendoza ME, et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703–11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manag. 2007;34(1):94–104.

    Article  Google Scholar 

  • 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  PubMed  Google Scholar 

  • Van Seventer R, et al. Linguistic validation of the DN4 for use in international studies. Eur J Pain. 2010;14:58–63.

    Article  PubMed  Google Scholar 

  • Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9–15.

    Article  PubMed  Google Scholar 

  • Wiffen PJ, Derry S, Naessens K, et al. Oral tapentadol for cancer pain. Cochrane Database Syst Rev. 2015;9:CD011460.

    Google Scholar 

  • Wiffen PJ, Wee B, Moore RA. Oral morphine for cancer pain. Cochrane Database Syst Rev. 2013;7:CD003868.

    Google Scholar 

  • Wong MH, Stockler MR, Pavlakis N. Bisphosphonates and other bone agents for breast cancer. Cochrane Database Syst Rev. 2012;2:CD003474.

    Google Scholar 

  • Yennurajalingam S, Kang JH, Hui D, et al. Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain. J Pain Symptom Manag. 2012;44(3):340–50.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geneviève Gridel .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Gridel, G., Zulian, G. (2017). Pain Management in Older Cancer Patients. In: Extermann, M. (eds) Geriatric Oncology . Springer, Cham. https://doi.org/10.1007/978-3-319-44870-1_11-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-44870-1_11-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44870-1

  • Online ISBN: 978-3-319-44870-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics