Unfortunately, some cancer survivors with chronic cancer-related pain meet significant barriers limiting their access to medications previously determined effective and well-tolerated. An unintended consequence is pain that had been well controlled during active cancer treatment becomes inadequately managed, resulting in unnecessary suffering. The American Academy of Hospice and Palliative Medicine (AAHPM) and the American Pain Society (APS) have provided guidelines to manage pain in cancer patients and survivors. Although the guidelines do reflect variations, the goal should be not to discontinue opioids, but to thoroughly assess the patient's pain and arrive at an appropriate management plan. Long-term opioid use may be necessary to treat cancer-related or non–cancer-related pain in cancer survivors. If opioids are to be initiated or continued, then the approach is to optimize their risk–benefit ratio through monitoring clinical effectiveness, addressing side effects, and monitoring adherence.
National Cancer Institute. Facing Forward: Life After Cancer Treatment. Available at: http://www.cancer.gov/cancertopics/life-after-treatment. Accessed August 11, 2010.
National Cancer Institute. Long Term Cancer Survivors: Research Initiatives. RFA: CA-04-003. Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA-CA-04-003.html. Accessed August 11, 2010.
National Cancer Institute. Surveillance Epidemiology and End Results. SEER Cancer Statistics Review 1975–2007. Available at: http://seer.cancer.gov/csr/1975_2007/index.html. Accessed August 11, 2010.
Polsky D, Doshi JA, Marcus S. Long-term risk for depressive symptoms after a medical diagnosis. Arch Intern Med 2005;165:1260–1266.
Himelhoch S, Weller WE, Wu AW. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Med Care 2004;42:512–521.
Cavaletti G, Zanna C. Current status and future prospects for the treatment of chemotherapy-induced peripheral neurotoxicity. Eur J Cancer 2002;38:1832–1837.
Burton AW, Fancuilllo GJ, Beasley RD. Pain in the cured cancer patient. In: Fisch MJ, Burton AW, eds. Cancer Pain Management. New York: McGraw Hill; 2007:155–163.
van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage 2002;24:429–436.
Gartner R, Jensen MB, Nielsen J. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009;302:1985–1992.
Landreneau RJ, Mack MJ, Hazelrigg SR. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg 1994;107:1079–1085; discussion 1085–1086.
Rannestad T, Skjeldestad FE. Pain and quality of life among long-term gynecological cancer survivors: a population-based case-control study. Acta Obstet Gynecol Scand 2007;86:1510–1516.
Swarm R, Abernethy AP, Anghelescu DL. NCCN clinical practice guidelines in oncology: adult cancer pain. Version 1, 2010. Available at: http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf. Accessed August 11, 2010.
American Pain Society. Guidelines for the Management of Cancer Pain in Adults and Children. Available at: www.ampainsoc.org. Accessed August 10, 2010.
American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain – sixth edition. Available at: www.ampainsoc.org. Accessed August 10, 2010.
Chou R, Fanciullo GJ, Fine PG. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain 2009;10:113–130.
Chou R, Ballantyne JC, Fanciullo GJ. Research gaps on use of opioids for chronic non-cancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guidelines. J Pain 2009;10:147–159.
Edlund MJ, Steffick D, Hudson T. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain 2007;129:355–362.
Kahan M, Srivastava A, Wilson L. Misuse of and dependence on opioids: study of chronic pain patients. Can Fam Physician 2006;52:1081–1087.
Manchikanti L, Manchukonda R, Damron KS. Does adherence monitoring reduce controlled substance abuse in chronic pain patients? Pain Physician 2006;9:57–60.