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Practice review: Evidence-based and effective management of pain in patients with advanced cancer

Chapman, Emma J; Edwards, Zoe; Boland, Jason W.; Maddocks, Matthew; Fettes, Lucy; Malia, Catherine; Mulvey, Matthew R; Bennett, Michael I

Authors

Emma J Chapman

Zoe Edwards

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Dr Jason Boland J.Boland@hull.ac.uk
Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine

Matthew Maddocks

Lucy Fettes

Catherine Malia

Matthew R Mulvey

Michael I Bennett



Abstract

© The Author(s) 2020. Background: Pain of a moderate or severe intensity affects over half of patients with advanced cancer and remains undertreated in at least one-third of these patients. Aim: The aim of this study was to provide a pragmatic overview of the evidence supporting the use of interventions in pain management in advanced cancer and to identify where encouraging preliminary results are demonstrated but further research is required. Design: A scoping review approach was used to examine the evidence supporting the use of guideline-recommended interventions in pain management practice. Data sources: National or international guidelines were selected if they described pain management in adult cancer patients and were written within the last 5 years in English. The Cochrane Database of Systematic Reviews (January 2014 to January 2019) was searched for ‘cancer’ AND ‘pain’ in the title, abstract or keywords. A MEDLINE search was also made. Results: A strong opioid remains the drug of choice for treating moderate or severe pain. Bisphosphonates and radiotherapy are also effective for cancer-related bone pain. Optimal management requires a tailored approach, support for self-management and review of treatment outcomes. There is likely a role for non-pharmacological approaches. Paracetamol should not be used in patients taking a strong opioid to treat pain. Cannabis-based medicines are not recommended. Weak opioids, ketamine and lidocaine are indicated in specific situations only. Conclusion: Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation.

Citation

Chapman, E. J., Edwards, Z., Boland, J. W., Maddocks, M., Fettes, L., Malia, C., …Bennett, M. I. (2020). Practice review: Evidence-based and effective management of pain in patients with advanced cancer. Palliative medicine, 34(4), 444-453. https://doi.org/10.1177/0269216319896955

Journal Article Type Review
Acceptance Date Dec 3, 2019
Online Publication Date Jan 24, 2020
Publication Date Apr 1, 2020
Deposit Date Feb 3, 2020
Publicly Available Date Mar 28, 2024
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 34
Issue 4
Pages 444-453
DOI https://doi.org/10.1177/0269216319896955
Keywords Anesthesiology and Pain Medicine; General Medicine
Public URL https://hull-repository.worktribe.com/output/3403772

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