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4 - The clinical science of cancer pain assessment and management

from Section 2 - Cancer Symptom Mechanisms and Models: Clinical and Basic Science

Published online by Cambridge University Press:  05 August 2011

By
Victor T. Chang  and
Russell K. Portenoy
Edited by
Charles S. Cleeland ,
Michael J. Fisch  and
Adrian J. Dunn
Victor T. Chang
Affiliation:
VA New Jersey Health Care System
Russell K. Portenoy
Affiliation:
Beth Israel Medical Center
Charles S. Cleeland
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Michael J. Fisch
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Adrian J. Dunn
Affiliation:
University of Hawaii, Manoa
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Summary

The assessment and management of cancer pain is a complex enterprise. This chapter will describe key elements of assessment and management, critique the emerging supportive evidence base, and discuss the basis for future studies of the underlying science.

Assessing cancer pain

Aspects of clinical practice

The goals of cancer pain assessment include characterization of the pain complaint and integration of information in a manner that leads to inferences about underlying pathophysiology and syndrome recognition. Th is understanding is the foundation for diverse management strategies that often rely on multiple modalities to relieve pain while minimizing side eff ects and treatment burden.

Pain measurement

Pain may be evaluated in terms of severity, location, quality, and other aspects. Among the most salient elements is measurement of pain intensity, which may be viewed as the cutting edge of the longstanding effort to develop a scientific foundation to assessment.

The scientifi c basis of patient ratings of pain intensity began more than half a century ago with the early development of clinical trials methodology for the evaluation of analgesics. These studies confirmed that a subjective experience like pain can be validly measured using self-reported rating scales. In the clinical setting, however, the measurement of cancer pain intensity often is beset by practical problems. Some patients are not able to respond with numerical descriptors. Other patients may have an impaired cognitive status or are simply unable to answer questions. This is an area where much work still needs to be done.

Type
Chapter
Information
Cancer Symptom Science
Measurement, Mechanisms, and Management
 , pp. 18 - 30
Publisher: Cambridge University Press
Print publication year: 2010

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References

Beecher, HK. The measurement of pain; prototype for the quantitative study of subjective responses. Pharmacol Rev 9(1):59–209, 1957.Google ScholarPubMed
Houde, RW. Methods for measuring clinical pain in humans. Acta Anaesthesiol Scand Suppl 74:25–29, 1982.CrossRefGoogle ScholarPubMed
Buffum, MD, Hutt, E, Chang, VT, Craine, MH, Snow, AL. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev 44(2):315–330, 2007.CrossRefGoogle ScholarPubMed
Serlin, RC, Mendoza, TR, Nakamura, Y, Edwards, KR, Cleeland, CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61(2):277–284, 1995.CrossRefGoogle ScholarPubMed
Hagen, NA, Elwood, T, Ernst, S. Cancer pain emergencies: a protocol for management. J Pain Symptom Manage 14(1):45–50, 1997.CrossRefGoogle ScholarPubMed
Moryl, N, Coyle, N, Foley, KM. Managing an acute pain crisis in a patient with advanced cancer: “this is as much of a crisis as a code”. JAMA 299(12):1457–1467, 2008.CrossRefGoogle Scholar
Rasmussen, PV, Sindrup, SH, Jensen, TS, Bach, FW. Symptoms and signs in patients with suspected neuropathic pain. Pain 110(1–2):461–469, 2004.CrossRefGoogle ScholarPubMed
Dworkin, RH, Jensen, MP, Gammaitoni, AR, Olaleye, , Galer, BS. Symptom profiles differ in patients with neuropathic versus non-neuropathic pain. J Pain 8(2):118–126, 2007.CrossRefGoogle ScholarPubMed
Ingham, J, Seidman, A, Yao, TJ, Lepore, J, Portenoy, R. An exploratory study of frequent pain measurement in a cancer clinical trial. Qual Life Res 5(5):503–507, 1996.CrossRefGoogle Scholar
Loblaw, DA, Wu, JS, Kirkbride, P, et al. Pain flare in patients with bone metastases after palliative radiotherapy: a nested randomized control trial. Support Care Cancer 15(4):451–455, 2007.CrossRefGoogle ScholarPubMed
Treede, RD, Jensen, TS, Campbell, JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70(18):1630–1635, 2008.CrossRefGoogle Scholar
Finnerup, NB, Jensen, TS. Mechanisms of disease: mechanism-based classification of neuropathic pain: a critical analysis. Nat Clin Pract Neurol 2(2):107–115, 2006.CrossRefGoogle ScholarPubMed
Bennett, MI, Attal, N, Backonja, MM, et al. Using screening tools to identify neuropathic pain. Pain 127(3):199–203, 2007.CrossRefGoogle ScholarPubMed
Foley, KM. Acute and chronic pain syndromes. In: Doyle, D, Hanks, G, Cherny, NI, Calman, K, eds. Oxford Textbook of Palliative Medicine. New York: Oxford University Press, 2004:298–316.Google Scholar
Windebank, AJ, Grisold, W. Chemotherapy-induced neuropathy. J Peripher Nerv Syst 13(1):27–46, 2008.CrossRefGoogle ScholarPubMed
Henry, NL, Giles, JT, Ang, D, et al. Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors. Breast Cancer Res Treat 111(2):365–372, 2008.CrossRefGoogle ScholarPubMed
Jensen, MP. The validity and reliability of pain measures in adults with cancer. J Pain 4(1):2–21, 2003.CrossRefGoogle ScholarPubMed
Patrick, DL, Ferketich, SL, Frame, PS, et al. National Institutes of Health State-of-the-Science Conference statement: symptom management in cancer: pain, depression, and fatigue, July 15–17, 2002. J Natl Cancer Inst 95(15):1110–1117, 2003.Google ScholarPubMed
Fairclough, DL, Wang, XS. Understanding the correlations between biologic and symptom measures over time. In: Lenderking, WR, Revicki, DA, eds. Advancing Health Outcomes Research Methods and Clinical Applications. McLean, VA: Degnon Associates, 2005:177–190.Google Scholar
Hjermstad, MJ, Gibbins, J, Haugen, DF, Caraceni, A, Loge, JH, Kaasa, S. Pain assessment tools in palliative care: an urgent need for consensus. Palliat Med 22(8):895–903, 2008.CrossRefGoogle ScholarPubMed
Knudsen, AK, Aass, N, Fainsinger, R, et al. Classification of pain in cancer patients: a systematic literature review. Palliat Med 23(4):295–308, 2009.CrossRefGoogle ScholarPubMed
Lai, JS, Dineen, K, Reeve, BB, et al. An item response theory-based pain item bank can enhance measurement precision. J Pain Symptom Manage 30(3):278–288, 2005.CrossRefGoogle ScholarPubMed
Patient-Reported Outcomes Measurement Information System. Welcome to PROMIS. Available from: URL: http://www.nihpromis.org. Accessed Oct 30, 2009.
Gendreau, M, Hufford, MR, Stone, AA. Measuring clinical pain in chronic widespread pain: selected methodological issues. Best Pract Res Clin Rheumatol 17(4):575–592, 2003.CrossRefGoogle ScholarPubMed
Hansson, P, Backonja, M, Bouhassira, D. Usefulness and limitations of quantitative sensory testing: clinical and research application in neuropathic pain states. Pain 129(3):256–259, 2007.CrossRefGoogle ScholarPubMed
Mogil, JS, Max, MB. The genetics of pain. In: McMahon, SB, Koltzenburg, M, eds. Wall and Melzack's Textbook of Pain. Philadelphia: Elsevier/Churchill Livingstone, 2006:159–174.CrossRefGoogle Scholar
Zaza, C, Baine, N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage 24(5):526–542, 2002.CrossRefGoogle ScholarPubMed
Langford, DJ, Crager, SE, Shehzad, Z, et al. Social modulation of pain as evidence for empathy in mice. Science 312(5782):1967–1970, 2006.CrossRefGoogle ScholarPubMed
Arcangeli, G, Giovinazzo, G, Saracino, B, et al. Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration. Int J Radiat Oncol Biol Phys 42(5):1119–1126, 1998.CrossRefGoogle ScholarPubMed
Delaney, A, Fleetwood-Walker, SM, Colvin, , Fallon, M. Translational medicine: cancer pain mechanisms and management. Br J Anaesth 101(1):87–94, 2008.CrossRefGoogle ScholarPubMed
Patchell, RA, Tibbs, PA, Regine, WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648, 2005.CrossRefGoogle ScholarPubMed
Dworkin, RH, Barbano, RL, Tyring, SK, et al. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain 142(3):209–217, 2009.CrossRefGoogle ScholarPubMed
Gilron, I, Coderre, TJ. Emerging drugs in neuropathic pain. Expert Opin Emerg Drugs 12(1):113–126, 2007.CrossRefGoogle ScholarPubMed
Exner, HJ, Peters, J, Eikermann, M. Epidural analgesia at end of life: facing empirical contraindications. Anesth Analg 97(6):1740–1742, 2003.CrossRefGoogle ScholarPubMed
Smith, TJ, Staats, PS, Deer, T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 20(19):4040–4049, 2002.CrossRefGoogle Scholar
Walker, SM, Goudas, LC, Cousins, MJ, Carr, DB. Combination spinal analgesic chemotherapy: a systematic review. Anesth Analg 95(3):674–715, 2002.Google ScholarPubMed
Wong, GY, Schroeder, DR, Carns, PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 291(9):1092–1099, 2004.CrossRefGoogle ScholarPubMed
Goudas, L, Carr, DB, Bloch, R, et al. Evidence Report/Technology Assessment No. 35: Management of Cancer Pain. Rockville MD: Agency for Healthcare Research and Quality, 2001. AHRQ publication 02–E002.
Carr, DB, Goudas, LC, Balk, EM, Bloch, R, Ioannidis, JP, Lau, J. Evidence report on the treatment of pain in cancer patients. J Natl Cancer Inst Monogr 32:23–31, 2004.CrossRefGoogle Scholar
Chow, E, Harris, K, Fan, G, Tsao, M, Sze, WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25(11):1423–1436, 2007.CrossRefGoogle ScholarPubMed
Erickson, MH. Hypnosis in painful terminal illness. J Ark Med Soc 56(2):67–71, 1959.Google ScholarPubMed
Rajasekaran, M, Edmonds, PM, Higginson, IL. Systematic review of hypnotherapy for treating symptoms in terminally ill adult cancer patients. Palliat Med 19(5):418–426, 2005.CrossRefGoogle ScholarPubMed
Tatrow, K, Montgomery, GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 29(1):17–27, 2006.CrossRefGoogle ScholarPubMed
Keefe, FJ, Abernethy, AP, Campbell, C. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol 56:601–630, 2005.CrossRefGoogle ScholarPubMed
Carr, DB, Loeser, JD, Morris, DB. Narrative, Pain, and Suffering. Seattle WA: IASP Press, 2005. Progress in Pain Research and Management; vol. 34.Google Scholar
Dy, SM, Asch, SM, Naeim, A, Sanati, H, Walling, A, Lorenz, KA. Evidence-based standards for cancer pain management. J Clin Oncol 26(23):3879–3885, 2008.CrossRefGoogle ScholarPubMed
Basbaum, AI, Bushnell, MC. Science of Pain. Oxford: Elsevier /Academic Press, 2009.Google Scholar
Pacharinsak, C, Beitz, A. Animal models of cancer pain. Comp Med 58(3):220–233, 2008.Google ScholarPubMed
Basbaum, AI. The future of pain therapy: something old, something new, something borrowed, and something blue. In: Merskey, H, Loeser, JD, Dubner, R, eds. The Paths of Pain, 1975–2005. Seattle WA: IASP Press, 2005:513–532.Google Scholar
Rice, AS, Cimino-Brown, D, Eisenach, JC, et al. Animal models and the prediction of efficacy in clinical trials of analgesic drugs: a critical appraisal and call for uniform reporting standards. Pain 139(2):243–247, 2008.CrossRefGoogle ScholarPubMed
Apolone, G, Corli, O, Caraceni, A, et al. Pattern and quality of care of cancer pain management: results from the Cancer Pain Outcome Research Study Group. Br J Cancer 100(10):1566–1574, 2009.CrossRefGoogle ScholarPubMed
Klungel, OH, Martens, EP, Psaty, BM, et al. Methods to assess intended effects of drug treatment in observational studies are reviewed. J Clin Epidemiol 57(12):1223–1231, 2004.CrossRefGoogle ScholarPubMed
D'Agostino, RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17(19):2265–2281, 1998.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Maida, V, Ennis, M, Irani, S, Corbo, M, Dolzhykov, M. Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring. J Support Oncol 6(3):119–124, 2008.Google ScholarPubMed
Penrod, JD, Goldstein, NE, Deb, P. When and how to use instrumental variables in palliative care research. J Palliat Med 12(5):471–474, 2009.CrossRefGoogle ScholarPubMed
Lorenz, KA, Dy, SM, Naeim, A, et al. Quality measures for supportive cancer care: the Cancer Quality-ASSIST Project. J Pain Symptom Manage 37(6):943–964, 2009.CrossRefGoogle ScholarPubMed
Fleming, TR. Current issues in non-inferiority trials. Stat Med 27(3):317–332, 2008.CrossRefGoogle ScholarPubMed
Williams, RL, Chen, ML, Hauck, WW. Equivalence approaches. Clin Pharmacol Ther 72(3):229–237, 2002.CrossRefGoogle ScholarPubMed
Haythornthwaite, JA. Clinical trials studying pharmacotherapy and psychological treatments alone and together. Neurology 65(12 Suppl 4):S20–S31, 2005.CrossRefGoogle ScholarPubMed
Russell, PB, Aveyard, SC, Oxenham, DR. An assessment of methods used to evaluate the adequacy of cancer pain management. J Pain Symptom Manage 32(6):581–588, 2006.CrossRefGoogle ScholarPubMed
Max, M, Portenoy, RK, Laska, EM. The Design of Analgesic Clinical Trials. New York: Raven Press, 1991. Advances in Pain Research and Therapy; vol. 18.
Farrar, JT, Young, JP, LaMoreaux, L, Werth, JL, Poole, RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158, 2001.CrossRefGoogle ScholarPubMed
Chow, E, Wu, JS, Hoskin, P, Coia, LR, Bentzen, SM, Blitzer, PH. International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Radiother Oncol 64(3):275–280, 2002.CrossRefGoogle ScholarPubMed
Dworkin, RH, Turk, DC, Farrar, JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 113(1–2):9–19, 2005.CrossRefGoogle ScholarPubMed
Turk, DC, Dworkin, RH, Allen, RR, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106(3):337–345, 2003.CrossRefGoogle ScholarPubMed
Turk, DC, Dworkin, RH, McDermott, MP, et al. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. Pain 139(3):485–493, 2008.CrossRefGoogle ScholarPubMed
Revicki, D, Hays, RD, Cella, D, Sloan, J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 61(2):102–109, 2008.CrossRefGoogle ScholarPubMed
US Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research, Center for Devices and Radiological Health. Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. Available from: URL: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071975.pdf. Accessed Dec 18, 2009.
Farrar, JT, Dworkin, RH, Max, MB. Use of the cumulative proportion of responders analysis graph to present pain data over a range of cut-off points: making clinical trial data more understandable. J Pain Symptom Manage 31(4):369–377, 2006.CrossRefGoogle Scholar
Gilron, I, Max, MB. Combination pharmacotherapy for neuropathic pain: current evidence and future directions. Expert Rev Neurother 5(6):823–830, 2005.CrossRefGoogle ScholarPubMed
Gilron, I, Bailey, JM, Tu, D, Holden, RR, Weaver, DF, Houlden, RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 352(13):1324–1334, 2005.CrossRefGoogle ScholarPubMed
Tallarida, RJ. Drug synergism: its detection and applications. J Pharmacol Exp Ther 298(3):865–872, 2001.Google ScholarPubMed
Tallarida, RJ. An overview of drug combination analysis with isobolograms. J Pharmacol Exp Ther 319(1):1–7, 2006.CrossRefGoogle ScholarPubMed
Black, DR, Sang, CN. Advances and limitations in the evaluation of analgesic combination therapy. Neurology 65(12 Suppl 4):S3–S6, 2005.CrossRefGoogle ScholarPubMed
Minto, CF, Schnider, TW, Short, TG, Gregg, KM, Gentilini, A, Shafer, SL. Response surface model for anesthetic drug interactions. Anesthesiology 92(6):1603–1616, 2000.CrossRefGoogle ScholarPubMed
Sveticic, G, Gentilini, A, Eichenberger, U, et al. Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: a novel optimization procedure. Anesthesiology 101(6):1381–1393, 2004.CrossRefGoogle ScholarPubMed
Reyes-Gibby, CC, Wu, X, Spitz, M, et al. Molecular epidemiology, cancer-related symptoms, and cytokines pathway. Lancet Oncol 9(8):777–785, 2008.CrossRefGoogle ScholarPubMed
Houde, RW. Pain and the patient with cancer. Med Clin North Am 40(3):687–703, 1956.CrossRefGoogle ScholarPubMed
Bell, R, Kalso, E, Paice, J, Soyannwo, O. A Global Problem: Cancer Pain From the Laboratory to the Bedside. Seattle WA: IASP Press, 2010.Google Scholar

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