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Pain Management
Supportive Care

Pediatric Cancer Pain May Be Misunderstood and Largely Undertreated

Cancer pain in children poses certain unique challenges. Over the past decade, insightful research into pediatric cancer pain has focused on pain management that incorporates nonopioid therapies into standard care. To shed light on this important issue, The ASCO Post spoke with Christine T....

pain management

FDA Requests Removal of Oxymorphone Hydrochloride for Risks Related to Abuse

On June 8,the U.S. Food and Drug Administration (FDA) requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated oxymorphone hydrochloride (Opana ER), from the market. After careful consideration, the agency is seeking removal based on its concern that the benefits of the...

symptom management
pain management

Peter Hoskin, MD, on Spinal Compression: Results From the SCORAD III Trial

Peter Hoskin, MD, of Mount Vernon Cancer Centre, discusses study findings on single-dose radiotherapy compared with multifraction radiotherapy in patients with metastatic spinal canal compression. (Abstract LBA10004)

pain management
symptom management

ASCO 2017: Single-Dose Radiotherapy as Effective as Multiple Fractions in Relieving Symptoms of Spinal Cord Compression

Spinal cord compression is a common complication in people with metastatic cancer and is a major detriment to quality of life. Radiation treatment is widely used to relieve pain and other symptoms, but there is no standard recommended schedule, and approaches currently vary. Findings from a phase...

issues in oncology
pain management

New Canadian Guideline Provides Advice to Physicians to Avoid Overprescribing of Opioids

Opioid overdoses are claiming the lives of thousands of Canadians. The impact of the opioid crisis continues to be devastating to individuals, families, and communities. Inappropriate prescribing of opioids has led to long-term dependence on this class of drugs. To help address problematic...

Health-Care Policy
Pain Management

ASCO Addresses New Policies That Threaten Access to Opioids

Since the mid-2000s, medication and illicit drug abuse in the United Sates has steadily increased, creating what has now been termed an “opioid epidemic.” In response, Congress and the Bush and Obama Administrations have launched intervention and regulatory proposals to help turn the troubling...

Pain Management

Combating Untreated Cancer-Related Pain

The problem of pain management facing clinicians today is twofold: how to ensure safe and effective treatment for patients with cancer in chronic pain, while avoiding the overuse of opioid medications and the potential for substance use disorder and diversion. According to the American Cancer...

Pain Management

Clinical Trials Actively Recruiting Patients With Cancer-Related Pain

Phase I Study Title: Qigong Mind-Body Exercise for Persistent Post-Surgical Pain in Breast Cancer Survivors: A Pilot Study Study Type: Phase I/interventional/single-group assignment Study Sponsor and Collaborators: Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Spaulding...

survivorship
pain management
breast cancer

Sophia Kustas Smith, PhD, MSW, on Depression and Fatigue: Self-Managed in 'Reimagine'

Sophia Kustas Smith, PhD, MSW, of Duke University, discusses study findings on an online, symptom self-management curriculum, known as www.reimagine.me, employed for breast cancer survivors with chronic pain (Abstract 182).

Pain Management

FDA Approves Extended-Release Morphine Product Formulated With Abuse-Deterrent Properties

On January 9, the U.S. Food and Drug Administration (FDA) ap­proved morphine sulfate extended-­release tablets with abuse-deterrent properties (Arymo ER), a C-II drug for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative...

pain management

FDA Approves Morphine Sulfate Extended-Release Tablets Formulated With Abuse-Deterrent Properties

On January 9, the U.S. Food and Drug Administration (FDA) approved morphine sulfate extended-release tablets formulated with abuse-deterrent properties (Arymo ER) for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative...

Pain Management
Symptom Management
Supportive Care
Issues in Oncology

Expect Questions About Medical Marijuana

“Whether or not individual professionals support the clinical use of herbal cannabis, all clinicians will encounter patients who elect to use it and therefore need to be prepared to advise them on cannabis-related clinical issues despite limited evidence to guide care,” according to a recently...

Supportive Care
Pain Management
Issues in Oncology
Symptom Management

Medical Marijuana: The Topic You Can’t Escape

With reports about new marijuana dispensaries sprouting up as more states approve the legal use of medical marijuana, and patients and family members questioning how to get it, medical marijuana is a “topic you can’t escape,” noted Judith A. Paice, PhD, RN.1 Dr. Paice is Director of the Cancer...

Pain Management
Survivorship

A Helping Hand, Just in Time: The ASCO Guideline for Managing Chronic Pain in Adult Cancer Survivors

With impeccable timing, as well as considerable forethought and planning, Dr. Paice and colleagues have produced a superb evidence-based guideline on “Management of Chronic Pain in Survivors of Adult Cancers.”1 (See this issue of The ASCO Post.) This summary of well-informed and thoroughly...

Pain Management
Survivorship

ASCO Clinical Practice Guideline on Management of Chronic Pain in Survivors of Adult Cancers

As reported in the Journal of Clinical Oncology by Judith A. Paice, PhD, RN, of Northwestern University, and colleagues, ASCO has released a clinical practice guideline on management of chronic pain in survivors of adult cancers.1 The guideline was based on literature review by an expert panel,...

pain management
global cancer care
palliative care

James F. Cleary, MD, on Global Access to Opioids

James F. Cleary, MD, of the University of Wisconsin Carbone Cancer Center, talks about the many reasons that 80% of the world’s population lacks access to opioids, the mainstay of cancer pain management.

palliative care
pain management
supportive care

Eduardo Bruera, MD, on Managing Opioid Use in Patients With a History of Addiction

Eduardo Bruera, MD, of The University of Texas MD Anderson Cancer Center, discusses the need for outpatient palliative care programs to monitor and support these complex patients and their family members.

survivorship
pain management

ASCO Releases Clinical Practice Guideline on Management of Chronic Pain in Survivors of Adult Cancers

As reported in the Journal of Clinical Oncology by Judith A. Paice, PhD, RN, of Northwestern University, and colleagues, ASCO has released a clinical practice guideline on management of chronic pain in survivors of adult cancers. The guideline was based on literature review by an expert panel, with ...

pain management

Fentanyl Nasal Spray Now Available at a Dose of 300 μg for Treatment of Breakthrough Cancer Pain

Fentanyl (Lazanda) nasal spray, a schedule II narcotic, is now available at a 300-μg dose to treat breakthrough cancer pain, offering physicians another titration option for dosing flexibility. The new strength can help physicians more easily and accurately target the appropriate dose for...

pain management

Early Study Looks to Achieve Chloride Homeostasis Through Gene Transfer to Alleviate Cancer-Related Neuropathic Pain

A study providing new information about neuropathic pain afflicting some 90% of cancer patients who have had nerve damage caused by tumors, surgery, chemotherapy, or radiation indicates gene therapy as a possible treatment. The study in rats showed transfer of a gene known as KCC2 into the spinal...

pain management

Judith Paice, PhD, RN, on Managing Cancer Pain: Strategies for Prescribing Opioids

Judith Paice, PhD, RN, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses strategies for safe opioid prescribing: making a comprehensive assessment, stratifying risk, using universal precautions, and educating practitioners on safe storage and disposal.

pain management
palliative care
symptom management
integrative oncology

Lorenzo Cohen, MD, on Acupuncture and Other Nondrug Pain Management Techniques

Lorenzo Cohen, MD, of The University of Texas MD Anderson Cancer Center, discusses nonpharmacologic approaches to symptom control. Techniques such as acupuncture for managing pain and chemotherapy-induced nausea and vomiting, or yoga and meditation to help improve quality of life, can be safely integrated into oncology care.

pain management

Judith Paice, PhD, RN, on Neuropathic Pain

Judith Paice, PhD, RN, of Northwestern University, reviews the current principles on assessing and treating neuropathic pain in cancer.

lung cancer
pain management

Brian D. Kavanagh, MD, on Improving Value and Elevating the Patient Care Experience

Brian D. Kavanagh, MD, of the University of Colorado School of Medicine, summarizes three papers: outcomes for locally advanced non–small cell lung cancer, 3D CRT vs image-guided intensity-modulated radiotherapy for reducing bowel toxicity, and dexamethasone for controlling pain flares in patients with bone metastases (Abstracts 2, 8, LBA6663).

Pain Management

First Fentanyl Nasal Spray Approved for Cancer Breakthrough Pain

The FDA has approved fentanyl nasal spray (Lazanda) for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. This marks the first FDA product approval for...

Pain Management

Shared REMS Approved for all Transmucosal Immediate-release Fentanyl Products

The FDA has approved a new transmucosal immediate-release fentanyl Risk Evaluation and Mitigation Strategy (REMS) access program. The REMS is a single shared system for all transmucosal immediate-release fentanyl products. Among the goals of the REMS access program are to mitigate the risk of...

Global Cancer Care
Pain Management

Inefficient Markets Impede Cancer Pain Relief

The potent analgesic property of morphine was first isolated in 1804, and after more than 2 centuries morphine is still the gold standard for moderate to severe pain. It is relatively easy to produce, and compared to most pharmaceuticals, morphine is dirt-cheap. Therein lies the cruel conundrum:...

Global Cancer Care
Pain Management
Palliative Care

Untreated Cancer Pain Remains a Significant Global Problem

“Physicians are afraid of morphine … Doctors [in Kenya] are so used to patients dying in pain … they think that this is how you must die. They are suspicious if you don’t die this way — [and feel] that you died prematurely.” —Human Rights Watch interview with Dr. John Weru of Nairobi Hospice,...

Pain Management

Screening for Distress and Unmet Needs in Patients with Cancer

In the past decade, “screening for distress has been positioned as the sixth vital sign in cancer care, in addition to the first five, which are measurements of pulse, respiration, blood pressure, temperature, and pain,” according to a review article in the Journal of Clinical Oncology. Although...

Pain Management
Palliative Care

Pain Remains Prevalent and Often Inadequately Treated among Cancer Outpatients

“Pain is as prevalent in ambulatory oncology patients with common solid tumors as it was more than 20 years ago, despite the fact that opioid prescribing in the United States has increased more than 10-fold since 1990,” according to results of a study among 3,023 ambulatory patients with cancer...

Supportive Care
Pain Management
Palliative Care

Early Access to Palliative/Supportive Care vs Usual Care Improves Pain Management

Many cancer patients remain undertreated for pain despite availability of guidelines and educational efforts to improve pain treatment. In a recent Annals of Oncology article, Bandieri and colleagues from the Italian Epidemiologia Clinico-Assistenziale del Dolore in Ospedale (ECAD-O) group report a ...

Supportive Care
Pain Management

SIDEBAR: Don’t Expect Direct Questions from Patients about Pain

Just asking patients “Is there something else you want to address in the visit,” rather than “Is there anything else you want to address in the visit today,” dramatically reduced patients’ unmet concerns during a primary care visit, according to a 2007 study.1 That learning can be applied to...

Supportive Care
Pain Management

Pain Remains Prevalent among Oncology Outpatients, with Odds of Undertreatment Twice as High among Minority Patients

In 1994, a landmark study of pain among oncology outpatients prompted a host of pain management initiatives.1 More than 18 years later, a recent study among more than 2,000 cancer outpatients has found that “one-third of the patients who had pain or used analgesics received inadequate treatment for ...

Pain Management

Study Reveals Global Picture of Obstacles to Pain Control in Patients with Cancer

Hundreds of millions of patients with cancer around the world are suffering from unrelieved cancer pain, despite the availability of morphine and other drugs that could alleviate that suffering. The major barriers are twofold: governments failing to ensure an adequate supply of morphine and other...

pain management

Duloxetine Reduced Painful Chemotherapy-induced Peripheral Neuropathy  

The use of duloxetine (Cymbalta) for 5 weeks “was associated with a statistically and clinically significant improvement” in painful chemotherapy-induced peripheral neuropathy when compared with placebo in a phase III randomized, double-blind crossover trial reported in the Journal of the American...

issues in oncology
pain management

New Labeling for Reformulated OxyContin to Curb Abuse 

The U.S. Food and Drug Administration has approved updated labeling for the reformulated painkiller OxyContin (controlled-release oxycodone hydrochloride). The new labeling will indicate that the drug has physical and chemical properties that make injection or snorting challenging. This new measure ...

pain management

Undertreatment of Cancer Pain Remains a Persistent Problem in Oncology 

Data indicate that for more than 2 decades, cancer pain has been undertreated in the United States. The paradox of this stubborn clinical problem is that oncology has the ability to manage the great majority of cancer pain. To clarify this issue, The ASCO Post recently spoke with nationally...

Pain Management

FDA Announces Class-Wide Safety Labeling Changes for Long-Acting Opioid Analgesics to Combat Abuse

The U.S. Food and Drug Administration (FDA) announced class-wide safety labeling changes and new postmarketing study requirements for all extended-release and long-acting opioid analgesics intended to treat pain. “The FDA is invoking its authority to require safety labeling changes and postmarket...

Pain Management

FDA Approves First Extended-Release, Single-Entity Hydrocodone Product

The U.S. Food and Drug Administration (FDA) today approved hydrocodone bitartrate extended-release capsules (Zohydro ER) for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate. The drug, a Schedule...

breast cancer
pain management

Postmastectomy Pain Effectively Treated With a Simple Injection

For postmastectomy neuropathic pain, perineural infiltration with a combination of bupivacaine and dexamethasone is a “simple, effective, practice-changing treatment that any surgeon can do,” according to Laura J. Esserman, MD, MBA, Professor of Surgery and Radiology at the University of...

pain management

Cancer Pain: The Humbling Reality

As a medical oncologist and palliative care physician, I’ve had the privilege of caring for cancer patients and delivering primary palliative care and symptom control, as well as the chance to care for patients especially referred for complex pain and symptom problems (in secondary and even...

pain management

Short-Term Follow-Up Reveals Suboptimal Pain Relief and Marked Pain Worsening in Ambulatory Patients With Cancer

In an analysis reported in the Journal of Clinical Oncology, Fengmin Zhao, MS, PhD, Dana-Farber Cancer Institute, Boston, and colleagues assessed factors associated with pain severity changes in ambulatory patients with invasive solid tumors (breast, prostate, colon/rectum, or lung) in the Eastern...

breast cancer
pain management

Exercise Program Reduces Aromatase Inhibitor–Associated Joint Pain

Amid studies of novel targeted therapies, genetic analyses of tumors, and new ways to approach the treatment of breast cancer, a low-tech study presented at the 2013 San Antonio Breast Cancer Symposium found that a yearlong exercise program reduced joint pain associated with aromatase inhibitors in ...

Pain Management

Individualized Care Key to Cancer Pain Management at Sidney Kimmel Comprehensive Cancer Center

Learning about the particulars of each cancer patient’s pain and treating each case uniquely is the key to keeping pain manageable. That is the goal of the Duffey Pain and Palliative Care Program at The Sidney Kimmel Comprehensive Cancer Center in Baltimore. The team consists of physicians, nurse...

pain management

Phase III Trial Reports Focused Ultrasound Reduces Cancer Pain

A phase III clinical trial has shown that noninvasive magnetic resonance-guided focused ultrasound treatment that heats the cancer within the bone, relieves pain and improves function for most patients when other treatment options are limited. The results were published recently in the Journal of...

pain management

Federal Pain Research Database Launched

The Interagency Pain Research Portfolio (IPRP), a database that provides information about pain research and training activities supported by the federal government, has been launched by six federal agencies. “This database will provide the public and the research community with an important tool...

pain management

Despite Growing Awareness, the Global Crisis of Untreated Cancer Pain Persists

Each day, millions of patients with cancer around the world suffer unrelieved pain because they are denied morphine, the gold standard of cancer pain control. The World Health Organization has called access to morphine a human rights issue. Not surprisingly, the crisis in unrelieved cancer pain is...

integrative oncology
pain management
symptom management

Acupuncture Treatment for Cancer Pain and Chemotherapy-Induced Peripheral Neuropathy

Acupuncture is a traditional Chinese medicine technique that involves inserting and manipulating filiform needles into specific points of the body to achieve a therapeutic effect. According to traditional Chinese medicine, disruptions in the flow of “vital energy” (qi) throughout the body are the...

integrative oncology
pain management

Study Shows Integrative Medicine Can Relieve Pain and Anxiety for Cancer Inpatients

Researchers at The Penny George Institute for Health and Healing in Minneapolis have found that integrative medicine therapies can decrease pain and anxiety for hospitalized cancer patients. Their findings were published recently in the Journal of the National Cancer Institute Monographs.1...

pain management

FDA Approves Labeling With Abuse-Deterrent Features for Extended-Release Opioid Analgesic

The U.S. Food and Drug Administration (FDA) has approved new labeling for morphine sulfate and naltrexone hydrochloride extended-release capsules. The drug, marketed as Embeda, is an opioid analgesic used to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and ...

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