Cancer

Treatment Guidelines Released For Cancer Pain | by Jessica Pyhtila | Lazarus AI | Sep, 2021

Jessica Pyhtila

By Jessica Pyhtila, PharmD, BCGP, BCPS

The American Society of Pain and Neuroscience recently released a set of best practices and guidelines on treating cancer-related pain from the primary pathology, metastasis, or side effects. Pain, which impacts around 80% of those with advanced cancer, can have a significant impact on a patient’s quality of life.

The guideline recommendations include:

-Considering opioids for moderate-to-severe pain, individualizing the choice of agent to account for pain presentations and comorbidities like kidney disease

-Methadone should be considered when other opioids are ineffective, with dosing initiation dependent on opioid tolerance

-Ketamine can be considered for refractory neuropathic, bone, and mucositis pain

-Radiation therapy can be considered for those with painful metastatic bone disease

-Osteoclast inhibitors can be considered on a case-by-case basis as an adjuvant therapy

-Early neurolysis is linked to better outcomes than late neurolysis

-Celiac plexus neurolysis should be used for moderate-to-severe abdominal pain from pancreatic cancer that is refractory to other therapies

-Superior hypogastric plexus neurolysis may be used in patients with intractable pain from pelvic cancers

-Ganglion impar neurolysis can be used in patients with intractable perineal cancer-related pain

-Spinal cord stimulation can be considered for refractory cancer pain, including pain linked to treatments like chemotherapy induced peripheral neuropathy

-Vertebral augmentation should be considered for those with spinal metastases that have caused symptomatic vertebral compression fractures

-Percutaneous radiofrequency ablation can be used for severe back pain from spinal tumors

-Nerve blocks using corticosteroid or radiofrequency lesioning to a peripheral nerve can be used for refractory cancer pain

-Surgical interventions for pain management may be an option for some patients, and include cordotomy for unilateral nociceptive pain, myelotomy for infra-diaphragmatic visceral pain, DREZ-otomy for focal limb pain and Pancoast tumors, and cingulotomy


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