Paice, J.A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., . . . Koyyalagunta, L. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical practice guideline. Journal of Clinical Oncology, JCO685206. Advance online publication.

DOI Link

Purpose & Patient Population

PURPOSE: To provide evidence-based guidance to clinicians regarding chronic pain management
 
TYPES OF PATIENTS ADDRESSED: Adults with cancer having chronic pain

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Methology staff graded all evidence. Graded evidence was reviewed by a panel of experts who then drafted guidelines, which were made available for comment.
 
INCLUSION CRITERIA: Articles on cancer or noncancer pain, survivors at risk for or with chronic pain, or adults without cancer; articles that reported on any outcomes such as pain, quality of life, function, etc.
 
EXCLUSION CRITERIA: Articles addressing acute pain

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship
 
APPLICATIONS: Palliative care 

Results Provided in the Reference

Thirty-five systematic reviews, 9 randomized controlled trials, and 19 other studies were used as the evidence base for the guidelines developed.

Guidelines & Recommendations

Nonpharmacologic interventions: Recommends that clinicians may directly prescribe or refer patients for interventions such as rehabilitation therapies, integrative therapies, interventions such a nerve blocks, psychological interventions, and nuerostimulatory therapies. Level of evidence was low to moderate, and strength of recommendations was weak for integrative therapies and neurostimulatory interventions.
 
Pharmacologic interventions: Recommendations include
  • Prescribing nonopioid analgesics and adjuvants, topical analgesics—moderate strength of recommendation and intermediate level evidence
  • Not prescribing corticosteroids for long-term use
Identifies recommended approaches for identification and prevention of opioid abuse and misuse

Limitations

  • Limited number of studies involved
  • Includes both cancer and noncancer studies
  • Incorporates refractory pain approaches with chronic pain evidence

Nursing Implications

Does not add substantially to the body of evidence or recommendations for chronic cancer-related pain management. Does suggest that effectiveness of long-term pain management should consider aspects such as functional impact and not just reduction in pain severity or other pain-specific outcomes. Provides new information regarding suggested approaches to address potential problems of analgesic abuse and misuse.