Opioid Addiction

Opioid addiction is still a concern in patients with cancer, especially as more and more patients continue to survive beyond 10 years. According to Dr Conway, that means the prescribers must carefully weigh the pros and cons of these medications.


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“If I am treating a patient with advanced, terminal disease, and I know that patient is likely addicted to the medication, am I going to fight the patient knowing that their time is limited and they have no other way to survive but on pain medication? No,” Dr Conway said.

However, there are rare situations where patients with cancer or cancer survivors begin to seek opioid medications from multiple providers, and that should be recognized as drug-seeking behavior, she said.

“Although it is only a small subset of patients, these patients have to be held accountable for such behavior,” Dr Conway said. “If I have any concern that a patient is receiving opioids from multiple providers I will hold them accountable to a pain contract, and if they violate that contract we will no longer prescribe for that patient.”

Non-Opioid Pain Management

Of course, there are management options for treating cancer-related pain outside of the use of opioids. Mild to moderate pain can be controlled with the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Other drugs may be used in conjunction or in place of opioids to help relieve cancer-related pain. These include antidepressants, which can treat tingling or burning pain from damaged nerves, antihistamines, which can help control nausea and itching, anti-anxiety drugs, which can treat muscle spasms, or anticonvulsants, which help control nerve pain.8

Ms Brady is also a big proponent of integrative therapy. “The clinic where I work has an acupuncturist, a massage therapist, and someone who does classes on mindfulness, and while patients are in the hospital there is music therapy, pet therapy, and a variety of other things available,” she said. “However, a lot of times these things may help, but will not be a complete fix.”

According to Dr Conway, oncology nurses, advance practitioners, and physicians have a responsibility to provide all types of supportive services for patients with cancer experiencing pain.

“That starts with assessing patients individually and not grouping everyone into one category,” Dr Conway said. “An individualized approach to care means understanding what type of pain they have, their goal of management, and what long-term outcomes we are seeking.”

References

1. Understanding the Epidemic. Drug overdose deaths in the United States continue to increase in 2015. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed November 29, 2017.

2. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. International Agency for Research on Cancer World Health Organization website. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed November 29, 2017.

3. van den Beuken-van Everdingen M. Chronic pain in cancer survivors: a growing issue. J Pain Palliat Care Pharmacother. 2012;26(4):385-387.

4. Glare PA, Davies PS, Finlay E, et al. Pain in cancer survivors. J Clin Oncol. 2014;32(16):1739-1747.

5. ASCO Answers Managing Cancer-Related Pain: A Guide for Patients, Families, and Caregivers. Alexandria, VA: American Society of Clinical Oncology; 2017. https://www.cancer.net/sites/cancer.net/files/managing_pain_booklet.pdf. Accessed November 29, 2017.

6. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65(No. RR-1):1-49.

7. Prescribing Policies: States Confront Opioid Overdose Epidemic. National Conference of State Legislatures website. http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx. Accessed November 29, 2017.

8. Non-opioids and other drugs used to treat cancer pain. American Cancer Society website. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/non-opioids-and-other-drugs-to-treat-cancer-pain.html. Accessed November 29, 2017.