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McMaster Textbook of Internal Medicine

Management of cancer pain: Challenging the evidence of the recent guidelines for opioid use in palliative care

2021-12-15
Geana P. Kurita, Per Sjøgren
From Polish Archives of Internal Medicine.

Full article

The article can be accessed free of charge through the website of Polish Archives of Internal Medicine.

Abstract

Opioid therapy is indisputably the mainstay of cancer pain management. However, important issues such as the worldwide variability in the availability and accessibility of opioids, myths and misconceptions about opioid use, and lack of knowledge about prescribing opioids among health-care professionals have been pointed out by researchers, clinicians, and several health organizations.

In an attempt to improve cancer pain management, guidelines for opioid use were elaborated to assist practitioners in prescribing opioids for the management of cancer-related pain. Recent opioid guidelines were developed based on a systematic assessment of evidence and they are considered one of the best resources to improve knowledge and clinical practice. However, most of the recommendations for cancer pain management included in these guidelines are based on low levels of evidence, which demonstrates that more studies on the use of opioids in pain management are necessary. Moreover, the increased frequency of prescribing opioids for chronic noncancer pain has raised other issues, such as iatrogenic adverse effects, which may also occur in patients with cancer pain on long-term opioid therapy (L-TOT).

In this narrative review, we discussed the role of opioid guidelines and recent knowledge regarding the consequences of L-TOT, in particular opioid addiction and deficiencies of the immune and endocrine systems. Finally, we addressed new strategies to strengthen the L-TOT in the management of cancer-related pain among patients in palliative care.

See also
  • The 3 most important recent advances in treating cancer pain with opioids Dr Per Sjøgren from University of Copenhagen, Denmark, shares his views on the 3 most important recent advances in treating cancer pain with opioids.
  • Biologic agents and small-molecule inhibitors in systemic autoimmune conditions: An update This review provides an updated overview of the mechanisms of action, therapeutic indications, efficacy, and safety of the currently available biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs), based on the results of randomized clinical trials and real-world studies.
  • Investigations and management of chronic cough: A 2020 update from the ERS Chronic Cough Task Force Chronic cough is a common condition that affects 7% to 11% of adults worldwide and accounts for a major burden of primary care visits in both developed and developing countries. The purpose of this review was to highlight the key messages on the management of chronic cough from the task force commissioned by the European Respiratory Society.
  • Human-important outcomes and EBM during the COVID-19 pandemic The pandemic brought with it an entire new realm of human suffering that is only indirectly related to disease itself—it relates to the societies’ ways of dealing with the illness. We propose that when making decisions about health-care interventions during this and during future pandemics, those “human-important outcomes” are carefully considered.
  • Chronic pain, opioids, and CBT Dr William Goldberg, clinical professor of medicine at McMaster University and Chief of Medicine at St Joseph’s Hospital from 1962-1982, comments on the issue of chronic opioid use.
  • Medical opioid controversy. Part 2: Key CPG messages Dr Gordon Guyatt, Distinguished Professor at McMaster University's Department of Health Research Methods, Evidence, and Impact and one of the founders of EBM, discusses key messages from the new Canadian guidelines on opioid use in chronic noncancer pain.
  • Medical opioid controversy. Part 1 Dr Gordon Guyatt, Distinguished Professor at McMaster University Department of Health Research Methods, Evidence, and Impact and one of the founders of evidence-based medicine, discusses new Canadian guidelines on opioid use in chronic noncancer pain.

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