What complementary and alternative therapies are useful for cancer pain? Fifty percent to 83% of cancer patients report the use of at least one type of complementary and alternative medicine (CAM) modality. CAM therapies include osteopathic manipulative treatment or other manual medicine technique (e.g., chiropractic, traditional Chinese and Ayurvedic medicine, naturopathy, and homeopathic medicine). Acupuncture, …
What non opioid analgesics are appropriate for patients with cancer pain? The selection of a nonopioid analgesic as a first-line agent for opioid naïve patients is encouraged, and if well-tolerated, that analgesic may be continued during initiation and up-titration of opioids. Consider NSAIDs or acetaminophen for mild to moderate pain, utilizing caution in patients with …
National Comprehensive Cancer Network approach to management of cancer pain that is not related to oncologic emergency The first step is to determine whether the patient is opioid naïve or opioid tolerant. In opioid naïve patients, consider titration of appropriate pharmacologic analgesics such that the dose relieves pain throughout the dosing interval but does not …
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What are the initial National Comprehensive Cancer Network recommendations for cancer pain screening and assessment? NCCN recommends the following: Screen all patients with cancer for pain. If no pain is present, rescreen at each visit. If pain is present, use a pain intensity rating scale to determine rates of current, usual, worst, and least pain …
Are there recommended guidelines or protocols for management of cancer pain? Yes, several consensus panels have established guidelines for cancer pain management. They include (but are not limited to) protocols developed by the National Comprehensive Cancer Network (NCCN) and The Joint Commission. American Pain Society guidelines for assessment and treatment of cancer pain in adults …
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What are the oncologic emergencies that cause pain? The most common painful emergencies associated with cancer are fracture of a weight-bearing bone, neuraxial metastasis with threatened neural injury (e.g., cauda equina syndrome), bacterial infection/sepsis, and obstructed or perforated viscus. Treatment for these conditions includes pain management as well as immediate treatment of the medical emergency.
Are additional symptoms common in patients with cancer who are experiencing pain? Yes, patients with cancer pain report significant rates of anhedonia, fatigue, low energy levels, trouble falling or staying asleep, cognitive impairment, dyspnea either at rest or with minor exertion, dry mouth, indigestion, nausea/vomiting, and drowsiness or excessive somnolence. Dysphoria is a common comorbid …
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