Pain Ladder of the Palliative Care Center for Cancer Pain Management. A New Perspective from Turkey Based on EFIC Standards
It is known that the pathophysiology and treatment strategies of cancer pain, acute and chronic pain, which are not clearly classified in the traditional approach to pain management, are different. Cancer pain is the most common symptom seen after cancer diagnosis and 40% of cancer patients who have completed curative treatment experience chronic pain. Many physicians who encounter patients with intractable pain are known to be concerned about using potent opioids due to their potential side effects.
To be more successful against cancer pain, educational strategies to address concerns about treating pain with strong opioids should be planned and implemented regularly.
Palliative Care Centers in our country are key in the care of cancer patients and in the treatment of cancer pain. First of all, it is more appropriate that these centers are preferably under the responsibility of Anesthesiology and Reanimation specialists as stated in the law, and their knowledge and experience about the use of all analgesics, especially opioids, and their side effects will also provide a significant advantage.
In this article, we offer some recommendations for the implementation of the standards established by EFIC (The European Pain Federation) on the management of cancer pain in our country.
1.Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O'Brien T, Mercadante S, et al. Standards for the management of cancerrelated pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain 2019;23:660–8. [CrossRef]
2. Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al; ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018;29(Suppl 4):iv166–91. [CrossRef]
3. Davies AN, Elsner F, Filbet MJ, Porta-Sales J, Ripamonti C, Santini D, et al. Breakthrough cancer pain (BTcP) management: a review of international and national guidelines. BMJ Support Palliat Care 2018;8:241–9. [CrossRef]
4. Swarm RA, Dans M. NCCN Frameworks for Resource Stratification of NCCN Guidelines: Adult Cancer Pain and Palliative Care. J Natl Compr Canc Netw 2018;16:628–31. [CrossRef]
5. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline From the American Pain Society, the american society of regional anesthesia and pain medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17:131–57. [CrossRef]
6. Jara C, Del Barco S, Grávalos C, Hoyos S, Hernández B, Muñoz M, et al. SEOM clinical guideline for treatment of cancer pain (2017). Clin Transl Oncol 2018;20:97–107. [CrossRef]
7. Bennett MI, Bagnall AM, José Closs S. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 2009;143:192–9. [CrossRef]
8. Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 2012;30:539–47.
9. Oldenmenger WH, Geerling JI, Mostovaya I, Vissers KCP, de Graeff A, Reyners AKL, et al. A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain. Cancer Treat Rev 2018;63:96–103.
10. Seamark DA, Williams S, Hall M, Lawrence CJ, Gilbert J. Palliative terminal cancer care in community hospitals and a hospice: a comparative study. Br J Gen Pract 1998;48:1312–6.
11. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018.
12. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49:1374–403. [CrossRef]
13. Minello C, George B, Allano G, Maindet C, Burnod A, Lemaire A. Assessing cancer pain-the first step toward improving patients' quality of life. Support Care Cancer 2019;27:3095–104.
14. Bennett MI, Kaasa S, Barke A, Korwisi B, Rief W, Treede RD; IASP Task force for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain 2019;160:38–44. [CrossRef]
15. Nugraha B, Gutenbrunner C, Barke A, Karst M, Schiller J, Schäfer P, et al; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain. Pain 2019;160:88–94.
16. Rodriguez C, Ji M, Wang HL, Padhya T, McMillan SC. Cancer pain and quality of life. J Hosp Palliat Nurs 2019;21:116–23.
17. Bennett MI. Mechanism-based cancer-pain therapy. Pain 2017;158(Suppl 1):S74–8. [CrossRef]
18. Hackett J, Godfrey M, Bennett MI. Patient and caregiver perspectives on managing pain in advanced cancer: a qualitative longitudinal study. Palliat Med 2016;30:711–9. [CrossRef]
19. Sloot S, Boland J, Snowden JA, Ezaydi Y, Foster A, Gethin A, et al. Side effects of analgesia may significantly reduce quality of life in symptomatic multiple myeloma: a cross-sectional prevalence study. Support Care Cancer 2015;23:671–8. [CrossRef]
20. Dreidi MM, Hamdan-Mansour AM. Pain, sleep disturbance, and quality of life among palestinian patients diagnosed with cancer. J Cancer Educ 2016;31:796–803. [CrossRef]
21. Raphael J, Ahmedzai S, Hester J, Urch C, Barrie J, Williams J, et al. Cancer pain: part 1: pathophysiology; oncological, pharmacological, and psychological treatments: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners. Pain Med 2010;11:742–64. [CrossRef]
22. Smith HS, Zhang JM, Baccei ML. Pathophysiology of Pain. In: Smith HS, ed. Current Therapy in Pain. 1st ed. Philadelphia: Elsevier Inc; 2009.
23. Schwittay A, Schumann C, Litzenburger BC, Schwenke K. Tapentadol prolonged release for severe chronic pain: results of a noninterventional study involving general practitioners and internists. J Pain Palliat Care Pharmacother 2013;27:225–34.
24. Mesía R, Virizuela Echaburu JA, Gómez J, Sauri T, Serrano G, Pujol E. Opioid-ınduced constipation in oncological patients: new strategies of management. Curr Treat Options Oncol 2019;20:91. [CrossRef]
25. ElMokhallalati Y, Mulvey MR, Bennett MI. Interventions to support self-management in cancer pain. Pain Rep 2018;3:e690.
26. International Pain Summit of the International Association for the Study of Pain. Declaration of Montréal: declaration that access to pain management is a fundamental human right. J Pain Palliat Care Pharmacother. 2011;25:29–31. [CrossRef]
27. Treede RD. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep 2018;3:e643.
28. TC Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü. Palyatif bakım hizmetlerinin uygulama usul ve esasları hakkında yönerge. 07.07.2015. Available at: https://shgm.saglik.gov. tr/Eklenti/38464/0/palyatif-bakim-hizmetlerinin-uygulamausul-ve-esaslari-hakkinda-yonergepdf.pdf . Accessed Sep 22, 2021.
29. Raphael J, Hester J, Ahmedzai S, Barrie J, Farqhuar-Smith P, Williams J,et al. Cancer pain: part 2: physical, interventional and complimentary therapies; management in the community; acute, treatment-related and complex cancer pain: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners. Pain Med. 2010;11:872–96. [CrossRef]