Treatment Guidelines Released For Cancer Pain
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
References:
Aman, Mansoor M.; Mahmoud, Ammar; Deer, Timothy; et al. “The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain,” Journal of Pain Research, July 16, 2021. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292624/
