3
Treatment
Treatment and Care Options
➤ Clinicians should aim to enhance comfort, improve function, limit
adverse events, and ensure safety in the management of pain in
cancer survivors. (Moderate Recommendation; IC-B-I)
➤ Clinicians should engage patient and family/caregivers in all aspects
of pain assessment and management. (Moderate Recommendation;
IC-B-I)
➤ Clinicians should determine the need for other health professionals
to provide comprehensive pain management care in patients with
complex needs. (Moderate Recommendation; IC-B-I)
• If deemed necessary, the clinician should define who is responsible for each aspect
of care and refer patients accordingly.
Nonpharmacologic Interventions
➤ Clinicians may prescribe directly or refer patients to other
professionals to provide the interventions outlined in Table 2 to
mitigate chronic pain or improve pain-related outcomes in cancer
survivors. (Moderate Recommendation; EB-B-I)
• These interventions must take into consideration pre-existing diagnoses and
comorbidities.
Pharmacologic Interventions
Miscellaneous Analgesics
➤ Clinicians may prescribe the following systemic nonopioid analgesics
and adjuvant analgesics to relieve chronic pain and/or improve
function in cancer survivors in whom no contraindications including
serious drug–drug interactions exist: (Moderate Recommendation;
EB-B-I)
• Nonsteroidal anti-inflammatory drugs
• Acetaminophen (paracetamol)
• Adjuvant analgesics, including selected antidepressants and selected
anticonvulsants with evidence of analgesic efficacy (such as the antidepressant
duloxetine and the anticonvulsants gabapentin and pregabalin) for neuropathic
pain conditions or chronic widespread pain.
Qualifying statement. The panel acknowledges that many other systemic nonopioids,
including many other antidepressants and anticonvulsants, drugs in many other classes
(such as the so-called muscle relaxants, benzodiazepines such as clonazepam, N-methyl-
D-aspartate receptor blockers such as ketamine, and a-2 agonists such as tizanidine),
and varied neutraceutical and botanicals marketed as complementary or alternative
medicines, are taken by some cancer survivors with chronic pain and may benefit some
of those who receive them. However, the efficacy of these agents and their long-term
effectiveness have not been established.
