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2014 ; 32
(16
): 1739-47
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Pain in cancer survivors
#MMPMID24799477
Glare PA
; Davies PS
; Finlay E
; Gulati A
; Lemanne D
; Moryl N
; Oeffinger KC
; Paice JA
; Stubblefield MD
; Syrjala KL
J Clin Oncol
2014[Jun]; 32
(16
): 1739-47
PMID24799477
show ga
Pain is a common problem in cancer survivors, especially in the first few years
after treatment. In the longer term, approximately 5% to 10% of survivors have
chronic severe pain that interferes with functioning. The prevalence is much
higher in certain subpopulations, such as breast cancer survivors. All cancer
treatment modalities have the potential to cause pain. Currently, the approach to
managing pain in cancer survivors is similar to that for chronic cancer-related
pain, pharmacotherapy being the principal treatment modality. Although it may be
appropriate to continue strong opioids in survivors with moderate to severe pain,
most pain problems in cancer survivors will not require them. Moreover, because
more than 40% of cancer survivors now live longer than 10 years, there is growing
concern about the long-term adverse effects of opioids and the risks of misuse,
abuse, and overdose in the nonpatient population. As with chronic nonmalignant
pain, multimodal interventions that incorporate nonpharmacologic therapies should
be part of the treatment strategy for pain in cancer survivors, prescribed with
the aim of restoring functionality, not just providing comfort. For patients with
complex pain issues, multidisciplinary programs should be used, if available. New
or worsening pain in a cancer survivor must be evaluated to determine whether the
cause is recurrent disease or a second malignancy. This article focuses on
patients with a history of cancer who are beyond the acute diagnosis and
treatment phase and on common treatment-related pain etiologies. The benefits and
harms of the various pharmacologic and nonpharmacologic options for pain
management in this setting are reviewed.