Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY.
J Clin Oncol. 2016 Sep 20;34(27):3325-45. doi: 10.1200/JCO.2016.68.5206. Epub 2016 Jul 25.
To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors.
An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation.
A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus.
Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.
为癌症幸存者慢性疼痛的最佳管理提供循证指导。
ASCO 召集的专家小组对调查癌症幸存者慢性疼痛管理的研究进行了系统的文献检索。感兴趣的结果包括症状缓解、疼痛强度、生活质量、功能结果、不良事件、滥用或转移以及风险评估或缓解。
共有 63 项研究符合入选标准，构成了建议的证据基础。研究在质量、规模和人群方面往往存在异质性。主要结局也因研究而异，在大多数情况下，由于使用不同的结局、测量和仪器以及在不同的时间点进行测量，因此无法直接比较。由于高质量证据的缺乏，许多建议是基于专家共识的。
临床医生应在每次就诊时筛查疼痛。对于报告新出现疼痛的任何患者，如果出现复发疾病、第二恶性肿瘤或迟发性治疗效应，应评估、治疗和监测。对于有复杂需求的患者，临床医生应确定是否需要其他卫生专业人员提供全面的疼痛管理护理。系统的非阿片类镇痛药和辅助镇痛药可用于缓解慢性疼痛和/或改善功能。对于对更保守治疗无反应且继续出现痛苦或功能障碍的精心挑选的癌症患者，临床医生可以开阿片类药物试验。应评估阿片类药物不良反应的风险。临床医生应清楚了解与阿片类药物使用相关的术语，如耐受性、依赖性、滥用和成瘾，并应采取通用预防措施以最大程度地减少滥用、成瘾和不良后果。更多信息可在 www.asco.org/chronic-pain-guideline 和 www.asco.org/guidelineswiki 上获得。
