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Pain Management

Last update: 09/08/2015

Pain Topics

Introduction | In the News | ResourcesResearch News

Bone Pain from Neulasta/Neupogen

It would be understandable if the community doctor recognized his or her limitations and partnered with a specialist, but we found in our survey that it is a very rare event when an oncologist refers a patient to a cancer pain specialist. Frequent referrals to pain or palliative care specialists were reported by only 14% and 16%, respectively. ASCO Post

Despite the availability of effective remedies our pain is often under-treated.  Anesthesiologists, neurologists, and neurosurgeons most frequently specialize in pain management.

Pain can result from the underlying lymphoma (or other medical conditions) or as a side effect of treatments.  It can be short-lived and acute, or chronic. 

It's important to honestly report pain to your doctor, particularly when it's persistent and affects your quality of life, and when the cause is not known.

The characteristics, intensity, and duration of the pain you report can help your doctors to understand the possible causes and make judgments about the appropriate remedies. 

Some characteristics of pain:

aching, dull, sharp, bloating, numbing, shooting
burning, pressing, soreness, cramping, pressure, stabbing,
comes and goes, pulling, throbbing
constant, radiating, tightness, cutting, searing
Source: jointcommission.org pdf  

PAL: Neuropathy, Peripheral

loss of feeling in limbs, ringing in the ears, deafness.
PAL: Talking about your pain: how to communicate about it effectively PAL
PAL: Symptoms checklist PAL

In the News:

The ASCO Post: Eduardo Bruera, MD
Managing #Cancer #Pain at the End of Life http://bit.ly/1g7OJcA
 The ASCO, 2013:
Under-treatment of Cancer Pain Remains a Persistent Problem in Oncology
A Conversation With Russell K. Portenoy, MD Post http://bit.ly/GHxqhF

Another more challenging category involves pain patients whose treatment requires a specialized set of skills that the general community oncologist probably won’t have—for instance, in the management of neuropathic pain or bone pain.

It would be understandable if the community doctor recognized his or her limitations and partnered with a specialist, but we found in our survey that it is a very rare event when an oncologist refers a patient to a cancer pain specialist. Frequent referrals to pain or palliative care specialists were reported by only 14% and 16%, respectively.
Pain - Annals Onc:
Management of cancer pain: ESMO Clinical Practice Guidelines
The Prepared Patient
When Pain Doesn't END

Bone Pain from Neulasta/Neupogen

Pain caused by growth factor support during chemotherapy can cause severe pain.  In this report, the intensity of pain decreased with NSAID use along with the duration of pain from "2.4 days with placebo to 1.92 days with naproxen (P = .005)." 

Anecdotal reports suggest that Claritin might be helpful to relieve this cause of bone pain.  However the short duration of the pain (that it's self-limiting) and the possibility of placebo effect cannot be discounted in such reports.  A controlled study is under way and should give us a reliable answer to that question. 


* Naproxen (NSAID) Reduces Bone Pain Induced By Pegfilgrastim (Neupogen) http://bit.ly/1r84TUl

Naproxen 500 mg twice daily or a matching placebo was administered on the morning of pegfilgrastim administration, which was given on days 2, 3, or 4 of the chemotherapy cycle. Naproxen was taken for a minimum of 5 days, and up to 8 days if pain continued.  Patients were excluded if they had active or past gastrointestinal bleeding, or if they had undergone heart surgery in the previous 6 months. Patients with myeloid malignancies were also excluded.

Recommended Resources: 

Topic Search on pain as side effect of treatment:  PubMed
Investigational Treatment for Chronic Pain in Patients With Advanced Cancer ClinicalTrials.gov

From CancerSupportiveCare.com

Pain | Types of Pain 
Emotional Sources 
Treatment Plan for Pain
Side Effects of Pain Medications
Myths about Narcotics and Cancer Pain Control
Supportive Techniques for Pain Control
Pain and Symptom Management Consultants

Cancer Pain Management - important NCCN updates
American Pain Foundation: painfoundation.org/
American Chronic Pain Association: theacpa.org/
Bill of Rights for Cancer Pain coninfo.nursing.uiowa.edu/
Cancer Pain Treatments: Radiation and chemotherapy  CancerPain.org
Conquering the Pain of Cancer MDACC PDF
Comprehensive pain management information cancer-pain.org 
In the Face of Pain: inthefaceofpain.com
Anxiety and depression PAL
Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain 
and Insomnia National Institutes of Health Technology Assessment Conference Statement
October 16-18, 1995  WEB
Myths about pain management childcancerpain.org
Pain Assessment Card  ich.ucl.ac.uk PDF

Also see: 

Palliative Care PAL
Resources & Research News
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Resources & Research News

Acetaminophen and Liver Injury: Q & A for Consumers FDA.gov 
Management of chronic pain in the elderly: focus on transdermal buprenorphine http://1.usa.gov/1jkKiIN
What You Should Know about Pain Management jointcommission.org pdf 
Music eases pain and depression healthology 

Compared to the control group, the music groups described a decrease in pain by 12 to 21 percent versus an increase of 1 to 2 percent. They also reported a decline in depression by 19 to 25 percent, and indicated they felt 9 to 18 percent less disabled and 5 to 8 percent more in charge of their pain. 
Efficacy of intravenous magnesium in neuropathic pain.
Br J Anaesth. 2002 Nov;89(5):711-4. PMID: 12393768  PubMed
Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia.
Neurology. 1998 Jun;50(6):1837-41. PubMed
Consequences and management of pain in herpes zoster.
J Infect Dis. 2002 Oct 15;186 Suppl 1:S83-90. Review. PubMed
Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2002 Oct 8;59(7):1015-21.   PubMed
Pain abstracts Doctors Guide
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