Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Abstract

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

Multidisciplinary intervention incorporating pharmacists in management of opioid‐naïve patients with moderate to severe cancer pain

“…It is recommended that patients with cancer‐related pain require management within an integrated system covering initial and ongoing assessment, comprehensive treatment and approach of adverse events (Swarm et al, ). Pharmacists play an increasingly important role in multidisciplinary management of cancer pain.…”

Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease

“…The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain identify central principles for the assessment and management of cancer pain in adults, including aspects of opioids, nonopioids, adjuvant analgesics, and broad multimodal care. 5 The target audience of the NCCN Guidelines for Adult Cancer Pain is healthcare practitioners who provide care to people with cancer, and the patient population covered by these guidelines is adults with cancer-related pain. The NCCN Guidelines for Adult Cancer Pain are authored by a panel of experts representing NCCN Member Institutions, all of which are NCI-designated cancer centers.…”

“…A recent JAMA Oncology article 3 highlighted perceived variability in the scope and recommendations among commonly used clinical practice guidelines for cancer-related pain. The article referenced guidelines from the Centers for Disease Control and Prevention (CDC), 4 NCCN, 5,6 and ASCO. 7 The authors of that article contend that variability in clinical practice guidelines may lead to confusion among primary care, oncology, and other prescribers, and highlight the need for collaboration among guideline developers to resolve inconsistencies in guideline recommendations.…”

The opioid epidemic in the United States—Overview, origins, and potential solutions

“…In part by issuing a 1996 consensus statement titled The Use of Opioids for the Treatment of Chronic Pain, some of the thought leaders advocated for the use of pain as a "fifth vital sign." 13,14 In 2004, the Federation of American Medical Boards joined the movement by encouraging state medical societies to enact physician punishments for undertreatment of pain. The Joint Commission proceeded to publish a Purdue Pharmasponsored guide, which stated that "some clinicians have inaccurate and exaggerated concerns [about risks of addiction] … This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control."…”

“…The National Cancer Center Network also published cancer pain guidelines that included escalating opioid pain treatment according to pain intensity on a scale of 0 to 10. 13,14 In 2004, the Federation of American Medical Boards joined the movement by encouraging state medical societies to enact physician punishments for undertreatment of pain. This policy was drafted by several individuals with ties to narcotics manufacturers.…”