ASCO issues first Clinical Practice Guidelines for chronic pain in adult cancer survivor
The American Society of Clinical Oncology (ASCO) has release the first guidelines on management of chronic pain in adult cancer survivors. Published online July 25, 2016 in the Journal of Clinical Oncology, these recommendations were developed by an expert panel with multidisciplinary representation, who used a systematic review of RCTs (1996 to 2015), observational studies and clinical experience to formulate the guidelines.
Some key recommendations in the new guidelines include the following:
- Patients should be screened for pain at each encounter.
- Clinicians should conduct an initial comprehensive pain assessment to explore the multidimensional nature of pain - pain descriptors, associated distress, functional impact, and related physical, psychological, social, and spiritual factors).
- Clinicians should be aware of chronic pain syndromes resulting from cancer treatments, the prevalence of these syndromes, risk factors for individual patients, and appropriate treatment options.
- Evaluate and monitor for recurrent disease, second malignancy, or late-onset treatment effects in patients with new-onset pain.
- Patient and family/caregivers should be involved in all aspects of pain assessment and management.
- Non opioid analgesics like NSAIDs, acetaminophen and adjuvant analgesics including selected antidepressants and selected anticonvulsants may be prescribed to relieve chronic pain if there are no contraindications and after assessment of the risks of adverse effects of pharmacologic therapies. Topical analgesics may also be prescribed.
- A trial of opioids may be prescribed in carefully selected cancer survivors with chronic pain who do not respond to more conservative management and who continue to experience pain-related distress or functional impairment. Assess risks of adverse effects of opioids used for pain management. Taper the dose, if they are no longer needed to avoid abstinence syndrome.
- Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids for pain control and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences.
- Clinicians should understand pertinent laws and regulations regarding the prescribing of controlled substances.
- Non pharmacologic therapies such as physical therapy, occupational therapy, cognitive-behavioral therapy, distraction, mindfulness, acupuncture, transcutaneous electrical nerve stimulation may be recommended.