Division of Geriatrics and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Palliat Med. 2019 Nov;22(11):1308-1317. doi: 10.1089/jpm.2019.0171. Epub 2019 Jul 22.
Palliative care (PC) teams increasingly care for patients with cancer into survivorship. Cancer survivorship transcends distinctions between acute, chronic, malignant, and nonmalignant pain. Partnering with oncologists, PC teams manage pain that persists after disease-directed treatment, evaluate changing symptoms as possible signs of cancer recurrence, taper opioids and mitigate risk of opioid misuse, and manage comorbid opioid use disorder (OUD). While interdisciplinary guidelines exist for pain management in survivorship, there is a need to develop a conceptual model that fully translates the biopsychosocial framework of PC into survivorship pain management. This review frames a model for pain management in cancer survivorship that balances analgesia with the imperative to minimize risk of OUD, recognizes signs of disease recurrence, and provides whole-person care. Comprehensive narrative review of the literature. Little guidance exists for co-management of pain, psychological distress, and opioid misuse in survivorship. We identified themes for whole-person pain management in survivorship: use of opioids and co-analgesic medications to prevent recurrent pain from residual tissue damage following cancer treatment, opioid tapering to the lowest effective dose, utilization of nonpharmacologic psychological interventions shown to reduce pain, screening for and management of OUD in partnership with addiction medicine specialists, maintaining vigilance for disease recurrence, and engaging in shared medical decision making. The management of pain in cancer survivorship is complex and requires interdisciplinary care that balances analgesia with the imperative to reduce long-term inappropriate opioid use and manage OUD, while maintaining therapeutic presence with patients in the spirit of PC.
姑息治疗（PC）团队越来越多地照顾癌症幸存者。癌症幸存者超越了急性、慢性、恶性和非恶性疼痛之间的区别。与肿瘤学家合作，PC 团队管理疾病导向治疗后持续存在的疼痛，评估可能是癌症复发迹象的不断变化的症状，逐渐减少阿片类药物并减轻阿片类药物滥用的风险，并管理并存的阿片类药物使用障碍（OUD）。虽然姑息治疗领域存在生存疼痛管理的跨学科指南，但需要开发一个概念模型，将 PC 的生物心理社会框架全面转化为生存疼痛管理。 这篇综述构建了一个癌症幸存者疼痛管理模型，该模型平衡了镇痛与最小化 OUD 风险的必要性，认识到疾病复发的迹象，并提供全面的整体护理。 对文献的全面叙述性综述。 关于生存中疼痛、心理困扰和阿片类药物滥用的共同管理，几乎没有指导。我们确定了生存中全面疼痛管理的主题：使用阿片类药物和辅助镇痛药物预防癌症治疗后残留组织损伤引起的复发性疼痛，逐渐减少阿片类药物用量至最低有效剂量，利用已证明可减轻疼痛的非药物心理干预措施，与成瘾医学专家合作筛查和管理 OUD，保持对疾病复发的警惕，以及进行共同的医疗决策。 癌症幸存者的疼痛管理非常复杂，需要跨学科护理，在平衡镇痛与减少长期不当阿片类药物使用和管理 OUD 的必要性的同时，保持与患者的治疗关系，秉承 PC 的精神。
