Opioid-Based Treatment Strategies for Persistent and Breakthrough Cancer Pain– Cancer pain is prevalent, often originating from the neoplasm or anticancer treatment, and frequently impairing multiple dimensions—physical, affective, and cognitive, among others. Despite a range of pharmacologic, nonpharmacologic, and interventional analgesic options, effective management is complicated by the intrinsically subjective nature of pain. Indeed, the cancer patient’s pain experience reflects nociceptive signaling filtered through genetic background, disease progression, activity levels, current psychological status, sociocultural influences, and existential concerns. These and other factors contribute to a dynamic condition in which pain levels and associated disability fluctuate over days, hours, and even minutes. At times, pain will rapidly spike despite otherwise effective around-the-clock treatment regimens. The result is transient, severe episodes of breakthrough pain that negatively affect patient mood, function, and/or quality of life. To optimize symptom control and maximize functional outcomes for patients with cancer, both persistent and breakthrough pain should be specifically assessed, differentially diagnosed, and treated. In the oncology setting, pain management frequently relies on opioid agonists, potentially in combination with nonopioid analgesics, behavioral therapies, and, in some cases, interventional approaches. Implementing and tailoring opioid-based treatment strategies require detailed evaluations of potential pain etiologies and patient-specific treatment goals and risks, a challenging proposition when combined with the myriad issues faced by oncologists and other healthcare providers who treat cancer patients. Therefore, educational programs are needed to disseminate evidence-based and practical approaches for assessing cancer-related persistent and breakthrough pain, prescribing opioids responsibly, tailoring therapy based on patient response, integrating palliative care, and coordinating multidisciplinary, collaborative care.
Comprehensively assess pain and associated functional impairment in patients with cancer.
Diagnose breakthrough pain and its subtypes across cancer patient populations.
Explain the respective roles of long-acting, short-acting, and rapid-onset opioids in the management of cancer pain.
Structure opioid therapy for cancer pain based on comprehensive and continual assessment of patient-specific risks. associated with opioid pharmacology and the potential for inappropriate medication use.
Tailor opioid-based therapy for breakthrough cancer pain based on temporal profile of the episodes, predictability, relationship with the baseline opioid regimen, and evaluation of potential benefits and risks of treatment.
2.0 Free CEUs for Nurses. This program is approved for 2.0 contact hours by the Oncology Nursing Society