NCCN Guidelines® Updates

NCCN Guidelines® Updates

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain published in this issue (page 992) include the latest updates. To assist readers interested in noting how the guidelines were updated, highlights of major changes pertaining to the abbreviated version published in this issue are printed below. To view the complete list of updates and full versions of these guidelines, visit the NCCN Web site at NCCN.org

Adult Cancer Pain

Updates in Version 2.2013 of the NCCN Guidelines for Adult Cancer Pain from Version 2.2012 include:

PAIN-1

  • Principles of Cancer Pain Management

    • 1st bullet was modified as: “There is increasing evidence in oncology that survival is linked to symptom pain control and that pain management contributes to quality-of-life improvement. To maximize patient outcomes, pain management is an essential part of oncologic management.”

    • 4th bullet was modified as: “Comprehensive pain assessment must be performed if pain is present.”

    • 7th bullet was modified as: “Pain intensity must be quantified and quality must be characterized by the patient...”

    • Three new bullets were added:

      • ▪ Goals of pain management are improved comfort and function.

      • ▪ Persistent cancer pain often requires treatment with regularly scheduled analgesics, and supplemental doses of analgesics are often required to manage breakthrough pain.

      • ▪ Optimize integrative interventions (See PAIN-J).

PAIN-2

  • Assessment, the following bullets were clarified as:

    • Comprehensive pain assessment (See PAIN-C) in order to identify pain

      • ▪ Pain etiology

      • ▪ Pain pathophysiology

      • ▪ Specific cancer pain syndrome (See PAIN-D)

      • Determine Patient goals for comfort and function

    • Pain related to an oncologic emergency

      • ▪ “Brain metastases” was removed.

  • Footnote “c” was modified by adding: “...and therefore have not developed significant tolerance. The FDA identifies tolerance as receiving at least 60 mg of morphine daily, at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer.” (Also for PAIN-3 and PAIN-4)

  • Footnote “d” was modified by adding: “The FDA identifies tolerance as receiving at least 60 mg of morphine daily, at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer.” (Also for PAIN-5 and PAIN-6)

PAIN-3

  • For ALL pain levels:

    • 7th bullet was added.

PAIN-5

  • Footnote “f” was added.

PAIN-6

  • For ALL pain levels:

    • 5th bullet was added.

PAIN-7

  • Ongoing care

    • 1st bullet was modified to add “...including extended-release or long-acting agent with rescue doses...”

    • 6th bullet, a sub-bullet was added: “Clarify which clinician will be prescribing patient’s ongoing analgesics.”

      • ▪ 8th bullet, a link to PAIN-I for patient and family/caregiver education was added.

The goal of the NCCN Guidelines® Updates is to provide readers with important changes that the NCCN Guidelines Panels have incorporated into an algorithm since it was last published. For a more complete detailing of the updated guideline’s modifications, please access the NCCN Guidelines® in this issue or, for the complete and most up-to-date version, at NCCN.org.

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