Management Of Cancer-related Pain Research Articles

Incorporating Music Therapy With Acupuncture in Managing Cancer Pain at an Acupuncture Practice.

Complementary and alternative medicine encompasses various nonpharmacologic interventions for managing pain, such as acupuncture and music therapy. Few studies have combined these two interventions in the management of cancer-related pain. The purpose of this evidence-based project was to compare acupuncture-only therapy versus dual therapy (acupuncture and music therapy) on pain intensity scores in patients with cancer. This evidence-based project included 102 participants at a private acupuncture practice. One group had acupuncture only for six weeks, and another had six weeks of acupuncture and music therapy. The Numeric Pain Rating Scale was used to assess pain before and after the interventions. Findings showed that both groups had clinically and statistically significant improvements in pain intensity scores. Although a significant difference was not noted between the two groups, acupuncture and music therapy were each found to be effective for managing cancer-related pain.

Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: a national survey.

The present investigation seeks to illuminate the current state and disparities in the knowledge, attitudes, and practices (KAP) among healthcare professionals regarding the management of lung cancer palliative care (LCPC) in China, while simultaneously assessing the prevalence and context of patient-controlled analgesia (PCA) usage in the management of cancer-related pain. A total of 2093 healthcare practitioners from 706 hospitals across China completed a structured questionnaire that probed various facets of LCPC management. The questionnaire consisted of seven thematic sections, incorporating chi-square tests and Fisher's exact probabilities to statistically assess the discrepancies in KAP among healthcare professionals across different hospital grades. Ordered data distributions among hospital grades were compared using non-parametric Kruskal-Wallis H and Mann-Whitney U tests. Multiple-choice items were subjected to multiple-response cross-tabulation analysis, while the Spearman rank-order correlation coefficient was employed to gauge potential associations among variables. Around 84.2% of the respondents perceived anti-tumor therapy to be of equal importance to palliative care. Statistically significant differences (χ² = 27.402, P = 0.002) in satisfaction levels were observed, with participants from Tertiary hospitals demonstrating higher satisfaction compared to those from Secondary and Primary hospitals. Pain emerged as the most prevalent symptom necessitating LCPC. Major impediments to LCPC adoption included patients' and families' concerns about the safety of long-term palliative care-related drug use. 31.1% of the respondents cited the most frequent rationale for PCA use as cases involving patients who required systemic administration of large opioid doses or exhibited intolerable adverse reactions to opioids. The principal deterrents against the use of PCA for cancer pain management were (1): apprehension about adverse drug reactions due to overdose (2), concern about the potential for opioid addiction, and (3) the anticipated increase in patients' economic burdens. Over the preceding 24-month period, 33.9% of the surveyed healthcare practitioners reported no engagement in either online or offline LCPC-related training initiatives. This study emphasizes the pressing need for comprehensive training in LCPC among Chinese health personnels, particularly focusing on the effective management of cancer pain symptoms.

Differences in Inpatient Management of Cancer-Related Pain Among Patients with Opioid Use Disorder.

The management of cancer-related pain in patients with opioid use disorder (OUD) remains complex and often challenging for clinicians and patients. There is currently a paucity of data to guide best practices, and the evidence that exists is variably applied. In this hospital-based questionnaire, we sought to understand the variation in practice patterns among clinicians in palliative medicine, addiction medicine, and hospital medicine, in caring for this complex patient population. Sixty-two questionnaire responses were analyzed and variation was found in management of pain, as well as initiation or titration of buprenorphine and methadone. There was also a significant difference in postdischarge subspecialty follow-up. Furthermore, the findings suggest that buprenorphine and methadone may be underutilized in this population. Patients and clinicians may benefit from additional support and standardization of practices to best manage coexisting cancer-related pain and OUD.

Challenges and Opportunities in Mobile Health Technologies for Cancer Pain Management: An Integrative Review

This article explores the evolving landscape of mobile cancer pain management, a critical aspect of healthcare innovation aimed at enhancing patient outcomes and accessibility to pain relief measures. Through a comprehensive analysis, the study examines the benefits, limitations, and potential strategies for overcoming the challenges associated with implementing mobile health technologies in the management of cancer-related pain. The discussion includes an evaluation of the effectiveness, patient adherence, and technological advancements in mobile health, alongside an assessment of the barriers hindering widespread adoption, such as cultural and technological literacy, resource allocation, and security concerns.

Exploring health professionals' knowledge of cancer-related pain: a scoping review.

Cancer-related pain is a complex multidimensional experience that affects all aspects of life. To support those impacted by cancer-related pain it is essential that health professionals have adequate knowledge in its assessment and management. To explore the knowledge of health professionals regarding cancer-related pain. A scoping review methodology was used to systematically search the literature published between 2010 and 2020. Databases CINAHL, Medline and PsycINFO were searched using terms 'cancer pain', 'healthcare professional', 'knowledge', 'attitudes' and 'barriers'. The search identified 38 articles. They focused on nursing knowledge with minimal involvement of allied health professionals. Knowledge levels were variable with the majority demonstrating poor knowledge. Common knowledge gaps included around fear of addiction, principles of cancer-related pain assessment and management, and interventional techniques. Knowledge of cancer-related pain is variable with several knowledge gaps. More work is needed to ensure health professionals have adequate knowledge regarding the complexity of cancer-related pain.

Cannabinoids for Cancer-related Pain Management: An Update on Therapeutic Applications and Future Perspectives.

Pain is a debilitating phenomenon that dramatically impairs the quality of life of patients. Many chronic conditions, including cancer, are associated with chronic pain. Despite pharmacological efforts that have been conducted, many patients suffering from cancer pain remain without treatment. To date, opioids are considered the preferred therapeutic choice for cancer-related pain management. Unfortunately, opioid treatment causes side effects and inefficiently relieves patients from pain, therefore alternative therapies have been considered, including Cannabis Sativa and cannabinoids. Accumulating evidence has highlighted that an increasing number of patients are choosing to use cannabis and cannabinoids for the management of their soothing and non-palliative cancer pain and other cancer-related symptoms. However, their clinical application must be supported by convincing and reproducible clinical trials. In this review, we provide an update on cannabinoid use for cancer pain management. Moreover, we tried to turn a light on the potential use of cannabis as a possible therapeutic option for cancer-related pain relief.

Adequacy of cancer-related pain management using the Pain Management Index among patients with cancer in the Northwest oncology centres of Ethiopia: an institutional-based cross-sectional study

ObjectiveThe aim of this study was to assess the adequacy of cancer-related pain (CRP) management and associated factors among patients with cancer in the Northwest oncology centres of Ethiopia.Design and...

Transcutaneous electrical acupoint stimulation for cancer-related pain management in patients receiving chronic opioid therapy: a randomized clinical trial.

The opioid crisis resulting from its use disorder and overdose poses additional challenges for cancer pain management. The American Society of Clinical Oncology Practice Guideline recommends acupuncture therapy for the management of adult cancer-related pain (CRP), but the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on CRP remains uncertain. This 5-week prospective randomized clinical trial was conducted at 2 hospitals in China, and participants with CRP receiving chronic opioid therapy were randomized 1:1 into two groups between December 2014 and June 2018. The true TEAS group underwent 15 sessions of TEAS treatments over 3 consecutive weeks, while the control group received sham stimulation. The primary outcome was the numerical rating scale (NRS) score in the past 24h at week 3. The secondary outcomes included morphine equivalent daily dose, quality of life and adverse events. A total of 159 participants were included in the modified intention-to-treat population. The baseline characteristics were similar in both groups. The mean NRS scores were 0.98 points at week 3 in the true TEAS group and 1.41 points in the sham group, with the mean difference between groups of -0.43 points (P < 0.001; OR = 0.68, P < 0.05). The proportion of patients with NRS reduction more than thirty percentage at week 3 was 50.00% in the true TEAS group and 35.44% in the sham group (RD = 0.15, P > 0.05; RR = 1.41, P > 0.05). No significant difference in pain intensity between the two groups was observed during the follow-up period without TEAS intervention (week 4, OR = 0.83, P > 0.05; week 5, OR = 0.83, P > 0.05). The Karnofsky Performance Status value suggested that patients in the true TEAS group experienced an improved quality of life (Between-group differences: week 3, 3.5%, P < 0.05; week 4, 4.6%, P < 0.001; week 5, 5.6%, P < 0.001). The 3-week application of TEAS in patients with CRP receiving chronic opioid therapy resulted in a statistically significant reduction in pain scores, but the observed reduction was of uncertain clinical significance. The prolonged analgesic effect of TEAS was not confirmed in this trial. GOV: ChiCTR-TRC-13003803.

Benefits, Harms, and Stakeholder Perspectives Regarding Opioid Therapy for Pain in Individuals With Metastatic Cancer: Protocol for a Descriptive Cohort Study.

Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. This manuscript outlines the protocol for the "Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study." The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients' pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. Data collection began in October 2022 and is anticipated to end by November 2024. Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. DERR1-10.2196/54953.

Payor-driven denials and delays for cancer-related supportive care medications.

78 Background: Prior authorization (PA) requires providers to obtain payor pre-approval for a prescribed treatment in order for it to be covered financially. While PA can be used to ensure adherence to evidence-based guidelines and to contain payor costs, it often results in delayed or denied care, which is problematic for patients with cancer who are seeking urgent management of symptoms. This analysis sought to describe PA-related denials and delays for supportive care medications among patients with cancer. Methods: All outpatient prescriptions at an urban comprehensive cancer center requiring PA from 2021-2022 were reviewed to characterize PA for supportive care medications. Prescriptions included long-acting opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone); non-opioid analgesics (duloxetine, pregabalin); and anti-emetics (aprepitant, dronabinol, granisetron, ondansetron, scopolamine). Prescription-level outcomes included decision status (approval vs. denial) and days to insurance decision. Bivariate analyses identified variations in PA denials by drug class and payor type. Among a subset of PA approvals for which data were available, we conducted bivariate analyses to evaluate associations of payor type and drug class with length of delay. Results: In the analysis period, 3304 supportive care medication prescriptions required PA: 2489 (75%) long-acting opioids; 131 (4%) non-opioid analgesics; 684 (21%) anti-emetics. Of these, 246 (8%) prescriptions were denied by the payor. The proportion of denied PAs for non-opioid analgesics (n=17; 13%) was greater than the proportion for opioids (n=182; 7%) and anti-emetics (n=17; 2%: χ2=6.5, df=2, p=.04). The proportion of denials among Medicare beneficiaries was greater than the proportion of denials among patients with private insurance, Medicaid, or Medicare Advantage plans (χ2=12.6, df=3, p=.006). Among denials, length from prescription entry to PA final denial ranged from 0-78 days (median=2.0), with no variation by payor type (F=0.85, p=.47). Among approved prescriptions with available data (n=851), 349 (41%) had same-day approval, with delays ranging from 1-54 days (median=2.0). Medicaid patients faced longer delays than patients from other payors (F=4.98, p=.002), with no difference in length of delay by drug class. Conclusions: The acute burden of cancer-related pain and nausea requires immediate mitigation, often with medication. PA can have a negative impact on the medication management of cancer-related pain and nausea: over one-half of supportive care medications had a ≥1 day delay, and 8% were denied altogether. Denials, or even brief delays, of provider-prescribed medication to ease symptom burden may lead to downstream increases in patient morbidity and payor costs, including symptom-related emergency room visits and hospitalization. Urgent efforts to reform PA are needed.

Implanted intrathecal drug delivery systems may be associated with improved survival in patients with cancer.

Intrathecal Drug Delivery Systems (IDDS) are underused in the management of cancer-related pain despite evidence of both efficacy and survival benefit. There is currently limited evidence to indicate which patients might benefit most from IDDS. The aim of the study was to describe the baseline characteristics and survival outcomes of patients who accepted IDDS, patients who declined IDDS and patients who wished to go ahead with IDDS but whose condition deteriorated before they could do so. The survival data for 75 consecutive patients who had been offered intrathecal drug delivery were examined as part of a retrospective cohort study. Survival data was compared between three groups: those who accepted intrathecal drug delivery and went on to receive it (n = 41), those who accepted it but whose condition deteriorated before it commenced (n = 17) and those who declined this treatment modality (n = 17). Patients who received IDDS survived significantly longer after assessment compared to those who declined IDDS (hazard ratio (HR) for the IDDS group relative to the declined group 0.29 (95% CI 0.16 to 0.53), and 0.23 (95% CI 0.12 to 0.44) after adjustment for gender and baseline functional status. In patients who accepted IDDS but who were unable to commence treatment, survival after assessment was not significantly different from those who declined the IDDS (HR for the deteriorated group relative to the declined group 1.28 (95% CI 0.65 to 2.53), and 0.80 (95% CI 0.65 to 2.53) after adjustment for gender and baseline functional status). In this retrospective analysis, an improvement in survival may be associated with patients who accept ongoing pain management with an implanted intrathecal drug delivery system compared to those patients who either declined intrathecal drug delivery or deteriorated before it could be commenced.

Global research trends in acupuncture for cancer pain: A bibliometric analysis.

In recent years, acupuncture has gained popularity in the management of cancer-related pain (CRP). This study aims to use bibliometric analysis to investigate the historical development, recent hotspots and research trends in this field. The Web of Science Core Collection database was selected as the data source for this study to retrieve and obtain literature related to acupuncture and CRP. Data analyses were performed with CiteSpace and VOSviewer to conduct the bibliometric analysis. This bibliometric analysis was conducted from 2000 to 2022. A total of 664 publications were included in this work. The number of publications has steadily increased over the last 2 decades. The United States has the largest number of published articles (244 papers), while the People's Republic of China has the highest centrality (0.48). The primary research institutions were Memorial Sloan-Kettering Cancer Center, Kyung Hee University and Beijing University of Chinese Medicine. Mao Jun J. was the most prolific author, while Heather Greenlee was the most cited one. The most productive journal was Integrative Cancer Therapies. The most frequent keywords excluding the search subject were "electroacupuncture," "management," "quality of life," "breast cancer," "Aromatase inhibitor," "neuropathic pain," "mechanisms," and "protocol." This study explored the application value of acupuncture in the management of CRP with bibliometric analysis, offering an intuitive understanding of this topic and revealing the hotspots and research trends.

Opioid Prescription Denials by Community Pharmacies for Cancer-Related Pain: A Case Series.

Pain is one of the most common symptoms experienced by patients living with cancer. Guidelines recommend opioids as the mainstay in the management of cancer-related pain. However, the opioid epidemic has resulted in policymakers recommending limitations on opioid prescribing which led to community pharmacies implementing various parameters. These restrictions have created barriers for patients with cancer-related pain attempting to fill opioid prescriptions from their community pharmacies. Additionally, in the setting of the opioid epidemic, there have been reports of systemic bias within community pharmacies, leading to experiences with embarrassment and shame for patients with cancer-related pain. This case series presents specific examples of community pharmacies declining to fill opioid prescriptions for patients with cancer-related pain and associated patient suffering.

Cancer-Related Pain Management in Suitable Intrathecal Therapy Candidates: A Spanish Multidisciplinary Expert Consensus.

A consensus is needed among healthcare professionals involved in easing oncological pain in patients who are suitable candidates for intrathecal therapy. A Delphi consultation was conducted, guided by a multidisciplinary scientific committee. The 18-item study questionnaire was designed based on a literature review together with a discussion group. The first-round questionnaire assessed experts' opinion of the current general practice, as well as their recommendation and treatment feasibility in the near future (2-3-year period) using a 9-point Likert scale. Items for which consensus was not achieved were included in a second round. Consensus was defined as ≥75% agreement (1-3 or 7-9). A total of 67 panelists (response rate: 63.2%) and 62 (92.5%) answered the first and second Delphi rounds, respectively. The participants were healthcare professionals from multiple medical disciplines who had an average of 17.6 (7.8) years of professional experience. A consensus was achieved on the recommendations (100%). The actions considered feasible to implement in the short term included effective multidisciplinary coordination, improvement in communication among the parties, and an assessment of patient satisfaction. Efforts should focus on overcoming the barriers identified, eventually leading to the provision of more comprehensive care and consideration of the patient's perspective.

The Effect of Aromatherapy in the Management of Cancer-Related Pain at the End of Life: A Pilot Study.

The use of clinical aromatherapy for managing pain has been studied in surgical patients and in women during childbirth. However, there are limited data on the use of aromatherapy for alleviating cancer-related pain, particularly at the end of life. This pilot study identifies the pre- and postimplementation effects of aromatherapy on pain level, pain perception, and the use of oral morphine equivalent among patients with cancer at the end of life. A survey was conducted to assess participant pain levels preimplementation of aromatherapy. Participants were then asked to rate their pain and describe how they felt 15 minutes postimplementation of aromatherapy. A chart review comparing oral morphine equivalent use pre- and postimplementation of aromatherapy was also performed. Postimplementation of aromatherapy, mean pain scores and 24-hour oral morphine equivalent use decreased. Participants also described an improved pain experience and found aromatherapy to be soothing.

Pharmacologic Management of Cancer-Related Pain in Pregnant Patients.

Despite being an essential part of whole-person care, patients with cancer often experience complex and under-treated pain. Managing cancer-related pain in patients who are also pregnant compounds the challenge for adequate pain management, as studies have largely excluded this population. Therapy for pain management should be guided by the cause and mechanism of pain. The objective of this review is to provide clinicians with an understanding of pain experienced by pregnant patients with cancer and medications that may be used to help manage cancer-related pain. Nociceptive pain results from damage to somatic or visceral tissues that may be directly caused by cancer. This type of pain can be managed in pregnant patients using acetaminophen and/or nonsteroidal antiinflammatory drugs as first-line agents. In nociceptive pain not managed by non-opioid analgesics, buprenorphine is recommended for those requiring chronic opioids to help manage their pain. Neuropathic pain that results from damage to the peripheral or central nervous system may also be directly caused by cancer, particularly chemotherapy. In pregnant patients, duloxetine and gabapentin should be considered first. Venlafaxine, pregabalin, tricyclic antidepressants, and sodium channel blockers should be avoided, if possible. Nociplastic pain is not directly caused by cancer but may be caused by ongoing peripheral nociceptive input or a condition that predates the cancer diagnosis. Duloxetine and gabapentin are reasonable agents to consider for treatment of nociceptive pain in pregnant patients. Cyclobenzaprine may also be helpful for nociplastic pain.

Chronic opioid use and effects on survival in patients with advanced stage malignancies treated with immunotherapy.

e14690 Background: While mu-opioid agonists are effective in management of cancer-related pain, chronic opioid use may cause immunosuppression, which is hypothesized to interfere with the efficacy of immune checkpoint inhibitors (ICIs). There is limited evidence on how duration of opioid use affects outcomes in patients receiving ICIs. Methods: We identified 212 patients at the University of Illinois Hospital and Health Sciences System who received an ICI between January 1, 2015 and July 31, 2021. Through retrospective assessment, we measured the number of months a patient received opioids from the time an ICI was initiated until either death or the end of follow-up. Overall survival (OS) and progression-free survival (PFS) were compared between patients who received opioids for different durations of time, using Kaplan-Meier curves and log-rank tests. Multivariate Cox models were employed to estimate hazard ratios for different durations of opioids use, controlled for patient and disease factors such as Eastern Cooperative Oncology Group Performance Status (ECOG PS) and age. Results: Of the 212 patients, 87% had solid tumors with stage IV disease, 11% had solid tumors with stage II or III disease, and 1% had Hodgkin’s disease. The majority (58%) were African-American, 19% were white and non-Hispanic, 17% were Hispanic, and race or ethnicity was other or unknown for 7%. 45% did not receive opioids, 14% received opioids but for less than half the duration of follow-up, 5% received opioids for at least half the duration of follow-up but not the entire duration, and 36% received opioids for the entire duration of follow-up. 90% had an ECOG PS of 0-2, 8% had an ECOG PS of 3-4, and 2% did not have an ECOG PS recorded. 66% began receiving an ICI at age 60 or older while 34% began receiving an ICI at age 59 or younger. ECOG PS of 3-4 was associated with shorter OS compared to ECOG PS of 0-2 (6 months vs 29 months, p = 0.0061), and starting an ICI at age 59 or younger was associated with a shorter OS compared to age 60 or older (17 months vs 38 months, p = 0.0233). Multivariate analysis controlling for age and ECOG PS revealed that patients who received an opioid for the entire duration of follow-up had a shorter OS compared to those who received an opioid for less than the entire duration or not at all (hazard ratio 1.850, p = 0.0070). There was not a statistically significant difference in PFS between patients who received an opioid for the entire duration of follow-up and patients who received an opioid for less than the entire duration or not at all (hazard ratio 1.418, p = 0.1711). Conclusions: These results suggest that longer duration of opioid use is associated with shorter overall survival in patients receiving ICIs, even when controlling for the independent risk factors of age and ECOG PS. Further investigation, including prospective analysis, is needed to further validate this association.

Oral Methadone versus Morphine IR for Patients with Cervical Cancer and Neuropathic Pain: A Prospective Randomised Controlled Trial.

In India, cervical cancer is the most common cancer among women and makes up for up to 29% of all registered cancer in females. Cancer-related pain is one of the major distressing symptoms for all cancer patients. Pain is characterised as somatic or neuropathic, and the total pain experience is often mixed. Conventional opioids are the backbone of analgesic treatment but are most often not sufficient in alleviating neuropathic pain, common in cervical cancer. Accumulating evidence of the advantage of methadone compared to conventional opioids, due to agonist action at both μ and q opioid receptors, N-methyl-D-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines has been demonstrated. We hypothesised that, with these properties', methadone might be a good option for the treatment of neuropathic pain in patients with cervical cancer. Patients with cervical cancer stages ll-lll were enrolled in this randomized controlled trial. A comparison was made between methadone versus immediate release morphine (IR morphine), with increasing doses until pain was controlled. Inclusion-period was from October 3rd to December 31st 2020, and the total patient-study period was 12 weeks. Pain intensity was assessed according to the Numeric Rating Scale (NRS) and Douleur Neuropathique (DN4). The primary objective was to determine whether methadone was clinically superior versus noninferior to morphine as an analgesic for the treatment of cancer related neuropathic pain in women with cervical cancer. A total of 85 women were included; five withdrew and six died during the study period, leaving 74 patients completing the study. All participants showed a reduction in mean values of NRS and DN4 from the time of inclusion and to the end of the study period, for IR morphine and methadone 8.4-2.7 and 8.6-1.5, respectively (P < 0.001). The DN4 score mean reduction for Morphine and Methadone were 6.12-1.37 and 6.05-0, respectively (P < 0.001). Side effects were more common in the group of patients receiving IR morphine compared to the patients treated with methadone. We found that Methadone had a superior analgesic effect with good overall tolerability compared with morphine as a first-line strong opioid for the management of cancer-related neuropathic pain.

Efficacy of Essential Oils in Relieving Cancer Pain: A Systematic Review and Meta-Analysis.

Over 80% of patients affected by cancer develops cancer-related pain, one of the most feared consequences because of its intractable nature, particularly in the terminal stage of the disease. Recent evidence-based recommendations on integrative medicine for the management of cancer pain underline the role of natural products. The present systematic review and meta-analysis aims at appraising for the first time the efficacy of aromatherapy in cancer pain in clinical studies with different design according to the most updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 recommendations. The search retrieves 1002 total records. Twelve studies are included and six are eligible for meta-analysis. The present study demonstrates significant efficacy of the use of essential oils in the reduction of the intensity of pain associated with cancer (p < 0.00001), highlighting the need for earlier, more homogeneous, and appropriately designed clinical trials. Good certainty body of evidence is needed for effective and safe management of cancer-related pain using essential oils by establishment of a step-by-step preclinical-to-clinical pathway to provide a rational basis for clinical use in integrative oncology. PROSPERO registration: CRD42023393182.

"It Is So Easy For Them to Dismiss": A Phenomenological Study of Cancer Survivors With Chronic Cancer-Related Pain.

Background: For many cancer survivors post-cure, chronic pain is a devastating complication of cancer treatment. The prevalence of chronic pain among cancer survivors is double that of the general population. However, little is known about the pain experience of cancer survivors who may have a different perspective than people with advanced cancer or people with noncancer pain. Objective: To understand the lived experience of chronic cancer-related pain in cancer survivors. Methods: We used a qualitative design with a descriptive phenomenological method to conduct in-depth interviews of 13 cancer survivors residing in the United States who completed curative cancer therapy, were at least three months from treatment, and experienced pain attributable to cancer. Data collection was focused on the lived experience and management of chronic cancer-related pain and a deep understanding of how the experience of chronic cancer-related pain shapes pain management choices. Results: The participants had a variety of primary cancer types and cancer pain syndromes. Three essential themes epitomized the experience of living with chronic cancer-related pain: invisible suffering at the cost of survival, an opioid paradox, and a lack of answers on what to expect and what might help. Conclusion and Implications: The results highlight an opportunity for pain self-management, education, and psychosocial interventions to optimize pain in cancer. Participants' experiences identify several opportunities to improve chronic cancer-related pain. Future efforts should prioritize access to multimodal pain treatments, high-quality communication, and expand clinicians' knowledge and skills to manage chronic pain.