Putting evidence into practice: what are the pharmacologic interventions for nociceptive and neuropathic cancer pain in adults?

Cancer pain continues to be undertreated in adults despite the substantial amount of research on pain management. The Oncology Nursing Society coordinated a team for the Putting Evidence Into Practice (PEP) project to develop (and update) a PEP resource summarizing the current evidence for the pharmacologic management of adults with nociceptive and neuropathic cancer pain. The aim of this article is to describe the development process and outcomes of the project. The review established that long-acting opioids in conjunction with immediate-release opioids are recommended for practice; radionuclides and radioisotopes as useful adjuncts for metastatic bone pain are likely to be effective; the effectiveness of tetrodotoxin, a neurotoxin, is not yet established; and spinal opioids, caffeine, or sympatholytic agents have beneficial and harmful effects and should be considered on an individual basis. Pain is a nursing-sensitive patient outcome; that is, pain can be directly affected by nursing interventions. Knowing the current evidence for pharmacologic management of cancer pain is critical to improve patient outcomes.