Exploring New Avenues in Pain Management for Patients With Cancer

Tumor Cell:© nevio - stock.adobe.com

When undergoing treatment for cancer, patients often endure pain due to the cancer or the treatment itself. Investigators are actively looking for new and novel approaches to enhance the efficacy and improve quality-of-life for these patients.¹

According to research published in the American Journal of Clinical Oncology led by Marcelen Rosenscheg, MD, a comprehensive analysis was conducted. Utilizing the LILACS, NCBI, and MEDLINE platforms, 2246 articles from the last 5 years were identified. Various descriptors were used to find these articles, including synonyms for pain treatment in oncology, pain management, complementary therapies, and more in Portuguese, English and Spanish.

What they found was that most treatments included acupuncture, opioids vs anti-inflammatories vs analgesics, radiotherapy, and behavioral therapies. Articles that focused on each of these options showed the benefits of utilizing these therapies, highlighting a better quality-of-life and tolerable adverse effects.

While these findings show the benefits of these interventions, the need for further research persists to help discern the most effective treatment options for cancer-related pain.

“Pain management for patients with cancer, in general, is effective, but there is still a need for extensive research in the fields of medication combinations and interventions, which have already shown significant improvement in the quality-of-life of patients with their use,” said Rosenscheg, Bonding Institution, Centro Universitário Campo Real, Guarapuava, Paraná, Brazil, in an interview with Targeted Oncology^TM.

In the interview, Rosenscheg discussed some of the methods that are used to treat pain in patients with cancer, and the importance of such research.

Targeted Oncology: What previous issues led to the initiation of this research?

Rosenscheg: We know that pain, in general, is 1 of the primary symptoms in clinical practice and that it is challenging to control. Therefore, the World Health Organization [WHO] has proposed a rigorous scale that defines how to treat patients most effectively, starting with analgesics and progressing to the use of opioids. However, even with this scale, it is difficult to maintain control over pain. Particularly, 1 of the distinctive characteristics of patients with cancer is related to this symptom, and the consequence is a significant impact on their quality-of-life. Therefore, research in this context is essential to transform the treatment of these patients and significantly improve their quality-of-life.

What were the main objectives of this research?

The idea of addressing this topic, not only within the medical field, which is my area, but also in a multidisciplinary context, is to emphasize the importance of treating pain in an interdisciplinary manner and to influence new proposals for effective oncological pain management.

Can you discuss the methods used in this systematic review?

The systematic review comes with a standard assembly. It is a truly systematic way of gathering relevant information for a single research project. The assembly of a protocol is essential for its consistency, as it is where the research project is written from start to finish with all the information to be used during the study. Our initial article was intended to be quite comprehensive, even more so than it turned out to be. However, this can also reduce the quality of the included articles, so some databases were not added in the final stage of the research.

In the end, we worked with 3 platforms: LILACS, NCBI, and MEDLINE in 2020 and 2021 over a span of 6 months. Within these platforms, we searched for everything related to the treatment of oncological pain, including medicinal, behavioral, and complementary treatments. We utilized platform filters to refine our searches. Initially, we found 2246 articles. Then, as was proposed in the protocol, we excluded several articles that were unrelated to the research, for example, articles on pain in non-oncological patients and those with inefficient methodology.

The selection of the research was carried out by 2 authors, with research selection being done alternately after the initial search, followed by an assessment of the studies' quality. Systematic reviews and randomized clinical trials were the most commonly used, resulting in a final inclusion of 24 articles. Summaries of the key points of the selected articles were created by 2 authors, with subsequent formatting of these summaries into tables. Some relevant results are described in the development section of the review.

Can you highlight some of the methods used in the treatment of pain in patients with cancer? What are the benefits derived from these treatments?

Many studies are related to acupuncture, attempting to demonstrate its effectiveness. Most of them are methodologically flawed, but, in general, there has been an improvement in pain in patients who frequently engage in this activity. Studies related to medication largely reaffirm what is already in use, that opioids are the best choice, with morphine, oxycodone, and fentanyl having the highest potential, respectively. Medication combinations have also been shown to significantly enhance the analgesic effect, such as the combination of pregabalin plus morphine and palbociclib [Ibrance] plus letrozole.

In addition to combinations, another important factor in medication use is the route of administration. There are significant differences in oral, intramuscular, and intravenous administration for each of them, and it is important to pay attention to this factor. In our study, it was mentioned that buprenorphine has a faster effect when administered sublingually, the only study involving the pediatric population, and the fentanyl patch has a faster onset of action than morphine with fewer [adverse] effects.

Pregabalin and morphine, in addition to reducing patients' pain, improve the quality and quantity of sleep. Overall, the benefits cited include a reduction in pain and an improvement in quality-of-life.

What are the main conclusions you can highlight from this research?

Pain management for patients with cancer, in general, is effective, but there is still a need for extensive research in the fields of medication combinations and interventions, which have already shown significant improvement in the quality-of-life of patients with their use. In addition, special populations, such as pediatric and geriatric patients, need special attention in this matter, as there are numerous factors that interfere with their perspective on pain.

What should a community oncologist take away from this research?

I believe the central idea of the research is to attempt to combine various pain-related treatments, providing not only a pharmacological approach but also a contribution from various healthcare fields, including physiotherapy, psychology, nutrition, etc., to enhance the quality-of-life of patients.

Is there anything else you would like to add?

Conducting a systematic review on this topic is quite complex because pain is a difficult symptom to quantify. Hence, there are various scales that differ in their attempts to better quantify it. However, for the sake of writing and reviewing, it would be interesting to have standardization to improve the comparison of studies. In this regard, the methodology of the studies is often flawed, which reduces the quality of the studies.

REFERENCE:

Rosenscheg M, Pedron J, Pedroso L. Treatment of cancer pain: a systematic review. Am J Clin Oncol. 2023;46(10):450-458. doi:10.1097/COC.0000000000001029