Recent advances in understanding and managing cancer pain

Abstract

Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host’s immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.

Patients' Self-Assessment of the Symptoms and Impact of Opioid-Induced Constipation: Results From a Prospective Observational Cohort Study of Japanese Patients With Cancer

“…2 For these patients, health care providers (HCPs) prescribe oxycodone, morphine, fentanyl, and other opioid analgesics, which are highly effective for alleviating cancer-related pain. 3,4 However, gastrointestinal (GI) side effects are common with these drugs because they stimulate peripheral m-opioid receptors in the GI tract, resulting in delayed gastric emptying, oral-cecal transit, and colonic transit. 5 Opioidinduced constipation (OIC) is the most common GI side effect of opioid therapy, resulting in the discontinuation of opioid treatment or reduction in opioid dose, compromising effective pain relief.…”

Long‐Term Opioid Therapy in Older Cancer Survivors: A Retrospective Cohort Study

“…This pain can last for months to years or even persist throughout a lifetime, with adverse impacts on functioning and quality of life . While nonopioid measures alone can often treat mild cancer‐related pain, opioids may be needed for treating more severe pain . However, there have been growing concerns regarding long‐term opioid therapy in older cancer survivors, in part due to the worsening epidemic of opioid toxicity in the United States …”

“…[6][7][8] While nonopioid measures alone can often treat mild cancerrelated pain, opioids may be needed for treating more severe pain. 4,9,10 However, there have been growing concerns regarding long-term opioid therapy in older cancer survivors, in part due to the worsening epidemic of opioid toxicity in the United States. 6,10,11 Past research has shown that long-term opioid therapy is a known risk factor for opioid-related toxicities, including opioid dependence, overdose, falls, fractures, and premature death.…”

“…4,9,10 However, there have been growing concerns regarding long-term opioid therapy in older cancer survivors, in part due to the worsening epidemic of opioid toxicity in the United States. 6,10,11 Past research has shown that long-term opioid therapy is a known risk factor for opioid-related toxicities, including opioid dependence, overdose, falls, fractures, and premature death. [12][13][14] Older cancer survivors are at particularly high risk for opioid toxicities because of age-associated alterations in drug metabolism, a high prevalence of multiple comorbidities, and polypharmacy.…”

Modeling cancer pain: “the times they are a-changin’”

“…Understanding cancer pain through this approach is a major key to provide an optimal management for our patients with cancer pain. Rather than a step-wise approach, this exhaustive pain medicine leads to multimodal and personalized responses, by associating interventional and integrated complementary approaches to current therapeutics strategies [4][5][6][7][8][9], and beyond, opening the way to supportive medicine in a simple, integrative, dynamic patients' management model. Integrating supportive medicine to cancer and serious chronic diseases pathway can be a key operational response, in parallel to the constant hyperspecialization of medicine.…”