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Information

Population: Women treated for ovarian cancer (Stages I–IV) with complete response.

Organization

ImagesASCO 2016

Recommendations

–Explore multidimensional nature of pain (pain descriptors, distress, impact on function and related physical, psychological, social, and spiritual factors)—explore information about cancer treatment history, comorbid conditions, and psychiatric history, including substance abuse as well as prior treatment for pain.

–Evaluate and monitor for recurrent disease, second cancer, or late-onset treatment effects in patients with new-onset pain (SOR: moderate).

–Prescribe nonopioid analgesics to relieve chronic pain or improve function in cancer survivors. This includes NSAIDs, acetaminophen, and adjuvant analgesics including antidepressants and selected anticonvulsants with evidence of analgesic efficacy (antidepressant duloxetine and anticonvulsants gabapentin and pregabalin) for neuropathic pain.

–Prescribe topical analgesics (NSAIDs, local anesthetics, or compounded creams/gels containing baclofen, amitriptyline, and ketamine).

–Do not use long-term corticosteroids solely to relieve chronic pain.

–Follow specific state regulations that allow access to medical cannabis for patients with chronic pain after consideration of benefits and risk.

– Consider a trial of opioids in carefully selected cancer survivors with chronic pain who do not respond to more conservative management and who continue to experience pain-related distress or functional impairment. Add nonopioid analgesics and/or adjuvants as clinically necessary. Assess risks of adverse effects of opioids, including persistent common adverse effects (constipation, mental clouding, upper GI symptoms), endocrinopathy (hypogonadism, hyperprolactinemia causing fatigue, infertility, reduced libido), and neurotoxicity (myoclonus, changes in mental status, opioid-induced hyperalgesia, new onset or worsening of sleep apnea syndrome).

Sources

–J Clin Oncol. 2016;34:3325-3345.

–J Pain Symptom Manage. 2016;51:1070-1090.

–J Clin Oncol. 2014;32:1739-1747.

–JAMA. 2016;315:1624-1645.

–ASCO. Management of Chronic Pain in Survivors of Adult Cancers: ASCO Clinical Practice Guideline. 2016.