Cancer-related pain

Presented at: EFIC Virtual Pain Education Summit

Speakers

Michael Bennett

St. Gemma's Professor of Palliative Medicine, Head of Academic Unit of Palliative Care Interim Director, Leeds Institute of Health Sciences, University of Leeds, United Kingdom
BIOGRAPHY
Sam Ahmedzai

NIHR CRN National Specialty Lead for Cancer - Supportive care and community-based research, United Kingdom
BIOGRAPHY
Manohar Sharma

Professor, The Walton Centre NHS Foundation Trust, University of Liverpool, United Kingdom
Nevenka Krcevski Skvarc

Assistant Professor, Anesthesiology, Pain Medicine and Palliative Care, Faculty of Medicine of University Maribor, Slovenia
BIOGRAPHY

Abstract

Chair: Michael Bennett, United Kingdom

New directions in cancer-related pain care
Michael Bennett, United Kingdom

This session will discuss pain in context of cancer, approaches to classification of cancer-related pain and finally treatment approaches in cancer-related pain care.

Cancer-related pain represents a wide spectrum of patients and mechanisms and must be assessed
in context of underlying disease. Opioids remain cornerstone of analgesic management in those with
active disease but should be used alongside supported self-management and tailored prescribing. There is a growing need to limit opioid load to minimise long term consequences.

Pain in cancer survivors
Sam H Ahmedzai, United Kingdom

Pain in cancer patients arises at all stages of the illness and recovery. It is often a presenting symptom at diagnosis, and initial therapeutic interventions such as biopsies, surgery and some forms of chemotherapy cause severe early pain. Usually this resolves, but in some cases it persists for many years, such as post-surgical wound pain and chemotherapy-induced neuropathic pain. With recent improvements in survival even in patients with locally advanced or metastatic disease, such as in breast or prostate cancer, pain can also persist for decades. Children treated successfully for cancer may present in adult life with late consequences such as painful avascular bone and joint destruction from high dose steroids or radiation.

Managing pain in cancer survivors starts with making a good assessment of the likely cause and impact on the patient and often the family. In older people, it is important to consider comorbidities. Clinical examination and tools such as the Brief Pain Inventory are most helpful. More detailed questionnaires or formal quantitative sensory testing are important in research, but less so for routine practice.

An important principle in treating pain in survivors is to understand that they mostly prefer not to be seen as a ‘patient’, but rather as a citizen trying to work, be a homemaker, do hobbies or study. Any medical intervention has to respect this by being ideally home-based, adaptable to changing circumstances such as taking holidays, and – most importantly – having minimal side-effects. Opioids are best avoid or only used for acute periods. Transdermal routes are often favoured to reduce tablet burden. Topical applications or acupuncture can also be used. In exceptional cases, invasive techniques such as intrathecal drug delivery or spinal cord stimulation may be considered.

Ideally the person with persistent pain and their family should be educated about tools of self-management, such as exercise and weight reduction. Some will need additional psychological support, not only for the pain but other longterm consequences of living with persistent cancer or treatment adverse effects.

Role of interventional pain management in cancer-related pain
Manohar Sharma, United Kingdom

Palliative care during COVID-19
Nevenka Krcevski Skvarc, Slovenia

Q&A