Yamaguchi, T., Shima, Y., Morita, T., Hosoya, M., Matoba, M., & Japanese Society of Palliative Medicine. (2013). Clinical guideline for pharmacological management of cancer pain: The Japanese Society of Palliative Medicine recommendations. Japanese Journal of Clinical Oncology, 43, 896–909.

PURPOSE: To summarize the recommendations and rationale for the pharmacologic management of cancer pain and identify the best practices in cancer pain management

TYPES OF PATIENTS ADDRESSED: Patients with cancer pain

RESOURCE TYPE: Consensus-based guideline  

PROCESS OF DEVELOPMENT: Task force established with 56 physicians, 25 pharmacists, 23 nurses, one epidemiologist, and seven other professionals; conducted systematic review; drafted recommendations using Delphi methods; developed recommendations based on GRADE system

DATABASES USED: PubMed, PaPaS, Cochrane, review of references in relevant guidelines, textbook review, review of JPSM and Palliative Medicine from January 2000–July 2008  

INCLUSION CRITERIA: Studies that evaluated drugs available in Japan

• PHASE OF CARE: Multiple phases of care 
• APPLICATIONS: Pediatrics, elder care, palliative care 

Sixty-five recommendations were created—24 for general cancer pain management, 24 for managing specific etiologic pain syndromes, 15 for managing opioid-induced adverse effects, and 2 for patient education.

Management of cancer pain includes assessment and an individualized approach to treating mild, moderate-to-severe, severe, and breakthrough pain. Opioids are the mainstay of treatment. Immediate-release (IR) or parenteral opioids should be used for unstable pain, whereas extended-release (ER) and IR opioids can be used for stable pain. Neuropathic pain should be managed with adjuvants (e.g., anticonvulsants, antidepressants, antiarrhythmics, ketamines, corticosteroids), metastatic bone pain with bisphosphonates, epigastric pain with celiac plexus block (pancreatic cancer), thoracic pain with nerve blocks, perineal pain with saddle block or superior hypogastric plexus block, malignant psoas syndrome with muscle relaxants or nerve block, and malignant bowel obstruction with octreotide, scopolamine, or corticosteroids. Adverse events of opioids should be judiciously treated: 1) nausea and vomiting with anti-dopaminergics, prokinetics, and antihistamines; opioid rotation, change of route, 2) constipation with laxatives; consider rotation to fentanyl, 3) drowsiness with psycho-stimulants; opioid rotation, route rotation. Patient education should be employed for all patients.

Only medications available in Japan are included. The focus is on pharmacologic interventions, but some psycho-educational aspects are included.

Patient education is an important part of pain management. In addition, nurses can recommend pharmacologic and procedural strategies to help manage pain in specific patient populations.