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Acute on Chronic Cancer Pain
Rafael Vazquez, MD; Nicole Z. Spence, MD; Sarah Ashley Low, MD
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KEY FACTS

  • Clinical Background

    TERMINOLOGY

    • Definitions

      • Cancer pain: Noxious chronic sensation due to malignancy with mass effect &/or invasion into adjacent tissues resulting in multifaceted pain intensified by emotional valence
      • Nociceptive pain: Noxious stimuli transmitted by specialized pain fibers to brain
        • Somatic: Noxious stimuli transmitted by discrete nerves; characterized by well-localized sharp discomfort
        • Visceral: Noxious stimuli transmitted by autonomic nervous system; characterized by poorly localized discomfort associated with disruption of viscera
      • Neuropathic pain: Nerve injury resulting in aberrant peripheral afferent signalling and distorted somatosensations
        • Incited by metabolic derangement, iatrogenic treatments, including medications (i.e., chemotherapeutics) &/or radiation therapy, or mechanical injury to nervous tissue via tumor invasion
      • Adjuvant analgesics: Drugs whose primary indications are that other than pain relief; however, they possess analgesic properties and are used to enhance opioid analgesia
      • Hyperalgesia: Hypersensitivity to pain
      • Allodynia: Nonpainful stimulus perceived as painful
      • Multimodal analgesia: Analgesic regimen that employs multiple analgesic modalities/medications for therapeutic synergy and side effect minimization
      • Preemptive analgesia: Analgesics strategically administered prior to insulting event in anticipation of pain

    Clinical Background

    • Cancer Pain

      • Management Strategies

        • Assessing Pain

          • Management of Acute on Chronic Cancer Pain

            Selected References

            1. Boceta J et al: Usability, acceptability, and usefulness of an mhealth app for diagnosing and monitoring patients with breakthrough cancer pain. JMIR Cancer. 5(1):e10187, 2019
            2. Morio K et al: Risk factors for polypharmacy in elderly patients with cancer pain. Am J Hosp Palliat Care. 36(7):598-602, 2019
            3. Prescribers' Digital Reference. http://www.PDR.net. Reviewed December 16, 2019. Accessed December 19, 2019.
            4. Swarm RA et al: Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 17(8):977-1007, 2019
            5. Smyth CE et al: Brief review: neuraxial analgesia in refractory malignant pain. Can J Anaesth. 61(2):141-53, 2014
            6. Leppert W et al: The role of corticosteroids in the treatment of pain in cancer patients. Curr Pain Headache Rep. 16(4):307-13, 2012
            7. Portenoy RK: Treatment of cancer pain. Lancet. 377(9784):2236-47, 2011
            8. Nersesyan H et al: Current aproach to cancer pain management: availability and implications of different treatment options. Ther Clin Risk Manag. 3(3):381-400, 2007
            9. Turk DC et al: Cancer patients in pain: considerations for assessing the whole person. Hematol Oncol Clin North Am. 16(3):511-25, 2002
            10. Miguel R: Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control. 7(2):149-56, 2000
            11. Wong DL et al: Pain in children: comparison of assessment scales. Pediatr Nurs. 14(1):9-17, 1988
            Related Anatomy
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            References
            Tables

            Tables

            KEY FACTS

            • Clinical Background

              TERMINOLOGY

              • Definitions

                • Cancer pain: Noxious chronic sensation due to malignancy with mass effect &/or invasion into adjacent tissues resulting in multifaceted pain intensified by emotional valence
                • Nociceptive pain: Noxious stimuli transmitted by specialized pain fibers to brain
                  • Somatic: Noxious stimuli transmitted by discrete nerves; characterized by well-localized sharp discomfort
                  • Visceral: Noxious stimuli transmitted by autonomic nervous system; characterized by poorly localized discomfort associated with disruption of viscera
                • Neuropathic pain: Nerve injury resulting in aberrant peripheral afferent signalling and distorted somatosensations
                  • Incited by metabolic derangement, iatrogenic treatments, including medications (i.e., chemotherapeutics) &/or radiation therapy, or mechanical injury to nervous tissue via tumor invasion
                • Adjuvant analgesics: Drugs whose primary indications are that other than pain relief; however, they possess analgesic properties and are used to enhance opioid analgesia
                • Hyperalgesia: Hypersensitivity to pain
                • Allodynia: Nonpainful stimulus perceived as painful
                • Multimodal analgesia: Analgesic regimen that employs multiple analgesic modalities/medications for therapeutic synergy and side effect minimization
                • Preemptive analgesia: Analgesics strategically administered prior to insulting event in anticipation of pain

              Clinical Background

              • Cancer Pain

                • Management Strategies

                  • Assessing Pain

                    • Management of Acute on Chronic Cancer Pain

                      Selected References

                      1. Boceta J et al: Usability, acceptability, and usefulness of an mhealth app for diagnosing and monitoring patients with breakthrough cancer pain. JMIR Cancer. 5(1):e10187, 2019
                      2. Morio K et al: Risk factors for polypharmacy in elderly patients with cancer pain. Am J Hosp Palliat Care. 36(7):598-602, 2019
                      3. Prescribers' Digital Reference. http://www.PDR.net. Reviewed December 16, 2019. Accessed December 19, 2019.
                      4. Swarm RA et al: Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 17(8):977-1007, 2019
                      5. Smyth CE et al: Brief review: neuraxial analgesia in refractory malignant pain. Can J Anaesth. 61(2):141-53, 2014
                      6. Leppert W et al: The role of corticosteroids in the treatment of pain in cancer patients. Curr Pain Headache Rep. 16(4):307-13, 2012
                      7. Portenoy RK: Treatment of cancer pain. Lancet. 377(9784):2236-47, 2011
                      8. Nersesyan H et al: Current aproach to cancer pain management: availability and implications of different treatment options. Ther Clin Risk Manag. 3(3):381-400, 2007
                      9. Turk DC et al: Cancer patients in pain: considerations for assessing the whole person. Hematol Oncol Clin North Am. 16(3):511-25, 2002
                      10. Miguel R: Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control. 7(2):149-56, 2000
                      11. Wong DL et al: Pain in children: comparison of assessment scales. Pediatr Nurs. 14(1):9-17, 1988