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

Abstract

Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and American Society of Clinical Oncology each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.

Diet/Nutrition: Ready to Transition from a Cancer Recurrence/Prevention Strategy to a Chronic Pain Management Modality for Cancer Survivors?

“…Additionally, in vitro evidence demonstrated the role of nuclear factor-kappa B (NF-κB), which has a critical role in cancer development and progression [85], as well as in regulating inflammatory pain [86]. Evidence also found that tomato extracts inhibited TNFα induced NF-κB activity in the androgen-independent human-derived prostate cancer cells [87].…”

Fisiopatología clínica en pacientes con enfermedad de células falciformes: la transición del dolor agudo al crónico

“…No fue habitual el uso de fármacos bloqueantes del receptor NMDA para evitar el efecto de tolerancia opioide a largo plazo. Las recomendaciones actuales sobre el uso de opioides en estos pacientes se basan en ajustar las expectativas del paciente junto a su familia y las metas a conseguir tanto en los episodios de dolor agudo como en el contexto de dolor crónico y entender la evolución de enfermedad (48), y están resumidas en la Tabla II.…”

“…RECOMENDACIONES GENERALES SOBRE EL USO DE OPIOIDES EN DOLOR DE LA ECF (46)(47)(48) 1. Ajustar las expectativas del paciente junto a su familia y las metas a conseguir, tanto en los episodios de dolor agudo como en el contexto de dolor crónico, y entender la evolución de enfermedad 2.…”

When treatment algorithms fail: A response to the development of a nomogram to determine the frequency of elevated risk for non-medical opioid use in cancer patients

“…We read the February 2021 article by Yennurajalingam et al (2021) with great interest given the growing recognition that individuals with cancer remain at risk for opioid misuse and overdose (Tan et al, 2015). Caring for this patient population requires carefully balancing risks to manage cancer-related pain while keeping patients safe from the risk of potential overdose (Alyssa et al, 2020). The authors developed a nomogram to help identify patients at-risk for non-medical opioid use (NMOU) and include a patient's race as a risk factor (Yennurajalingam et al, 2021).…”