ASCO issues guidelines for chronic pain in patients with a history of adult cancer

Screening for pain at every visit is recommended, and management and treatment options are specified.

Clinicians who see patients with chronic pain and a history of cancer as an adult should screen them for pain at every visit, according to the American Society of Clinical Oncology (ASCO) Clinical Practice Guideline published in the Journal of Clinical Oncology.

The ASCO authors, led by Judith A. Paice, PhD, RN, a Research Professor in the Division of Hematology/Oncology at Northwestern University Feinberg School of Medicine in Chicago, reviewed 63 studies to come to a consensus on the recommendations.

“As a result of extraordinary advancements in diagnosis and treatment, approximately 14 million individuals with a history of cancer (excluding nonmelanomatous skin cancers) are living in the United States,” Dr Paice and colleagues wrote. “Two thirds of these individuals are surviving ≥5 years after diagnosis.”

The authors highlighted the following as their main recommendations:

Clinicians should use a quantitative or semiquantitative tool to screen for pain at each encounter.
If a patient reports new onset of pain, clinicians should evaluate and monitor for recurrent disease, second malignancy, or late-onset effects of treatment.
To relieve pain in patients with no contraindications, clinicians should use systemic nonopioid analgesics, including nonsteroidal anti-inflammatory drugs and acetaminophen, and adjuvant analgesics, including antidepressants such as duloxetine and anticonvulsants such as gabapentin and pregabalin, which have been shown to be effective for neuropathic or chronic pain.

In addition, the guideline details the appropriate use of opioids, universal precautions against abuse, addiction, and adverse effects to opioids, and evidence for referral to specialized care or alternative interventions. The complete guideline can be found at www.asco.org/chronic-pain-guideline.

The authors said that their rationale for recommending the assessment of pain at every encounter included an understanding that each patient may experience pain differently. “Some patients may even be reluctant to discuss their pain, seeing it as a sign of weakness or fearing a recurrence; some may see it as an expected and untreatable complication of their cancer treatment.”

They suggested that involving the patient in a discussion of how the pain is affecting them and in developing a pain management plan may improve outcomes and quality of life. “Survivors who understand all aspects of their pain treatment plan (and their role in it) may have a better overall outcome.”

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