title: Treatment Considerations for Cancer Pain: A Global Perspective.
abstract: Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. Reasons for undertreating cancer pain include attitudes of patients, clinicians, and factors associated with healthcare systems. The consequences of not treating cancer pain may include reduced quality of life for patients with cancer (who now live longer than ever), functional decline, and increased psychological stress. Early analgesic intervention for cancer pain may reduce the risk of central sensitization and chronification of pain. To manage pain in oncology patients, clinicians should assess pain during regular follow-up visits using validated pain measurement tools and follow prescribing guidelines, if necessary referring patients with cancer to pain specialists. Many patients with cancer require opioids for pain relief. Pain associated with cancer may also relate to cancer treatments, such as chemotherapy-induced peripheral neuropathy. Many patients with cancer are what might be considered "special populations," in that they may be elderly, frail, comorbid, or have end-stage organ failure. Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes.
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.|Association of Chronic Pain Patients, Houston, Texas, U.S.A.|Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Pergolizzi
authors.affiliation: Department of Anesthesiology and Pain Medicine, New York University School of Medicine, New York City, New York, U.S.A.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gharibo
authors.affiliation: Raffles Pain Management Centre, Raffles Hospital, Singapore City, Singapore.
authors.forename: Kok-Yuen
authors.initials: KY
authors.lastname: Ho
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012846:Singapore
chemical_list: D000700:Analgesics
keywords: cancer; opioid analgesics; pain; pain assessment; pain measurement