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. 2021 Jun;10(1):605-617.
doi: 10.1007/s40122-021-00248-x. Epub 2021 Mar 17.

Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Giustino Varrassi  1 , Flaminia Coluzzi  2   3 , Vittorio A Guardamagna  4 , Filomena Puntillo  5 , Giovanni Sotgiu  6 , Renato Vellucci  7 ; Rational Use of Analgesics (RUA) Group
Collaborators, Affiliations

Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Giustino Varrassi et al. Pain Ther. 2021 Jun.

Abstract

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer.

Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3-4.

Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients' needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction.

Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer.

Keywords: Breakthrough pain; Cancer pain; Opioid-induced bowel dysfunction (OIBD); Opioid-induced constipation (OIC); Opioids.

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References

    1. Caraceni A, Shkodra M. Cancer pain assessment and classification. Cancers (Basel) 2019;11(4):510. doi: 10.3390/cancers11040510. - DOI - PMC - PubMed
    1. Van den Beuken-van MH, Hochstenbach LM, Joosten EA, et al. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51:1070–1090. doi: 10.1016/j.jpainsymman.2015.12.340. - DOI - PubMed
    1. Zis P, Paladini A, Piroli A, et al. Pain as a first manifestation of paraneoplastic neuropathies: a systematic review and meta-analysis. Pain Ther. 2017;6(16):143–151. doi: 10.1007/s40122-017-0076-3. - DOI - PMC - PubMed
    1. Zis P, Varrassi G. Painful peripheral neuropathy and cancer. Pain Ther. 2017;6:115–116. doi: 10.1007/s40122-017-0077-2. - DOI - PMC - PubMed
    1. Scarborough B, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin. 2018;68(3):182–196. doi: 10.3322/caac.21453. - DOI - PMC - PubMed

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