Opioids in Cancer Pain: Right or Privilege? (original) (raw)
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Journal of Opioid Management , 2021
A growing number of individuals live with an Opioid Use Disorder (OUD). While many go on to recover from such disorders, certainly there will be individuals in palliative care at some point who still suffer with OUD . One of the major barriers to palliative care for individuals recovering and currently suffering from an OUD is the stigma related to having an OUD. Therefore, in the context of palliative care it is important to understand the relationship that exists between palliative care, OUDs, and how stereotypes related to substance use disorders affect patient engagement in palliative care. For this paper, the focus will be on how stereotypes affect pain management in palliative care for persons with an OUD. A review of current literature regarding OUDs and pain management indicates a need for care specific to the needs of those in palliative care who formerly and/or currently suffer from an OUD in order to avoid relapse or worsening of their affliction while still managing their pain. The striking lack of knowledge and resources regarding opioid use disorders and their treatment indicates a need to strengthen/increase resources for physicians to educate on treating OUDs as well as alternatives for pain management. This article presents dignity-enhancing care as a gateway to fairly treat individuals with an OUD and to get rid of the stigma associated with OUD patients.
Oncology in Clinical Practice, 2021
Failure to alleviate cancer pain may deteriorate mental functioning, increase depression symptoms, result in the clinical diagnosis of demoralization syndrome nonadherence of treatment, functioning discipline, which together, may precipitate desire for euthanasia. Increased incidence of pain in patients with advanced or terminal disease has been reported to range from 39% to 66.4% depending on the stage of the cancer being experienced. Further, the progressive aging of societies and increased life expectancy in cancer patients has changed the dynamics of modern treatment processes. Despite their efficacy, the use of opioids as an analgesic treatment during terminal disease has been affected by the quality, availability, and negative reputation of these scheduled drugs. This review aims to describe the specific factors and limitations of opioid pain management from the perspective of patients and their caregivers. Further, we aim to identify and discuss the key factors which determine the success or failure of opioid use for the treatment of pain with links to internationally recognized recommendations and current research.
Opioid Therapy in Cancer Patients and Survivors at Risk of Addiction, Misuse or Complex Dependency
Frontiers in Pain Research, 2021
A clinical conundrum can occur when a patient with active opioid use disorder (OUD) or at elevated risk for the condition presents with cancer and related painful symptoms. Despite earlier beliefs that cancer patients were relatively unaffected by opioid misuse, it appears that cancer patients have similar risks as the general population for OUD but are more likely to need and take opioids. Treating such patients requires an individualized approach, informed consent, and a shared decision-making model. Tools exist to help stratify patients for risk of OUD. While improved clinician education in pain control is needed, patients too need to be better informed about the risks and benefits of opioids. Patients may fear pain more than OUD, but opioids are not always the most effective pain reliever for a given patient and some patients do not tolerate or want to take opioids. The association of OUD with mental health disorders (dual diagnosis) can also complicate delivery of care as patie...
Controlling pain and reducing misuse of opioids: ethical considerations
Canadian family physician Médecin de famille canadien, 2012
To help family physicians achieve an ethical balance in their opioid prescribing practices. MEDLINE was searched for English-language articles published between 1985 and 2011. Most available evidence was level III. It is essential to follow practice guidelines when prescribing opioids, except when another course of action is demonstrably justified. In addition, when considering the appropriateness of an opioid prescription, with its many ethical implications, the decision can be usefully guided by the application of the ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice. As well, it is essential to keep current about legal and regulatory changes and provincial electronic registries of opioid prescriptions. Physicians need to ensure that their patients' pain is properly assessed and managed. Reaching optimal pain control might necessitate prescribing opioids. But the obligation to provide pain relief needs to be balanced with an equally important...
Journal of Pain and Symptom Management, 2021
Context.-The opioid epidemic spurred guidelines intended to reduce inappropriate prescribing. Although acute cancer-related pain was excluded from these recommendations, studies demonstrate reduced opioid prescribing for patients hospitalized with advanced cancer. Objectives.-We performed a matched case-control analysis to determine how a history of opioid use disorder (OUD) affects inpatient management of cancer pain. Methods.-Charts of patients with OUD admitted for cancer pain from 2015-2020 were retrospectively reviewed. Hospitalizations were matched 1:1 by patient age and sex. Home milligram-morphine equivalent per day (MME/day) was calculated from the home medication list. Admission MME/day was the average MME/day administered during hospitalization. Results.-A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. Cancer was metastatic/relapsed for 70% of admissions. The median overall survival was 2.3 months (95% CI 0-5.21, P = 0.13). Patients with OUD had a significantly lower change from Home to Admission MME/day (−3 vs. 37, P < 0.01) and were less likely to have any increase in Admission MME/day (OR 0.1, 95% CI 0.02-0.43, P < 0.01). When considering opioids administered after pain specialty consultation, there was no difference between groups.
Cancer-Related Pain Management and the Optimal Use of Opioids
Acta médica portuguesa
Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics â by a registered medical practitioner for absolute pain control â is a legitimate practice. In this article we look at patientsâ fears and physiciansâ generalhesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.
Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer
Nature Reviews Clinical Oncology, 2018
Pain is one of the most frequent and distressing symptoms in patients diagnosed with cancer. It might be short term as a result of invasive procedures, surgery, radiation therapy or chemotherapy, or it might be chronic (Table 1). Clinical evidence supports the use of opioid analgesics as the gold standard in cancer-related pain 1 , but their benefits must be carefully balanced against potential complications. Some patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, which can result in untoward adverse effects, accidental overdose or even death of the patient or others. Over the years, this issue has become increasingly concerning, culminating in an opioid overdose epidemic in the USA and other countries that has left the medical community, government agencies and other stakeholders grappling with ways to address it 2. Contrary to previous perceptions, emerging data suggest that patients with cancer are also at risk of NMOU 3,4. In this Review, we examine the role of opioids in managing cancer-related pain, the risk of NMOU and substance use disorder (SUD) and methods to achieve the right balance between the two in order to ensure safe opioid use. Opioids for cancer-related pain Opioids produce analgesia by binding to opioid receptors along the nociceptive pathway to reduce transmission of the impulses and perception of pain at the somatosensory cortex. Some pain syndromes 5,6 (Table 1) might be controlled appropriately with non-opioids, such as NSAIDs and acetaminophen and/or adjuvant analgesics (medications that are mainly indicated for conditions other than pain, such as seizure and depression, but that can also have analgesic effects when used alone or in combination with other analgesics) 1. When pain is persistent and refractory to these measures, opioids are usually necessary. Opioids include morphine, oxycodone, hydrocodone, tramadol, hydromorphone, oxymorphone, fentanyl, buprenorphine and methadone. Morphine is considered the prototype opioid analgesic and the first drug of choice in cancer-related pain, mostly because it is relatively more common, available and accessible-but not necessarily more effectivethan the other opioids. In fact, multiple randomized controlled trials have found no major differences between morphine and other opioids in regard to analgesia and adverse effect profiles 1. The use and titration of methadone are complex and should preferably be reserved for professionals with a high level of expertise, such as supportive or palliative care specialists and pain medicine specialists 1. Concerns have been raised about the efficacy of buprenorphine, owing to its partial agonist activity, which might result in limited additional analgesic benefit but increased likelihood of adverse reactions
Opioids and Cancer Survivors: Issues in Side-Effect Management
Oncology Nursing Forum, 2008
➤ Opioid analgesics for treatment of moderate to severe pain in patients with cancer are an essential part of pain management. ➤ The use of opioids often is associated with side effects, including sedation, constipation, nausea and vomiting, and cognitive impairment. ➤ The late and long-term effects on survivors who require pain treatment are poorly understood and underinvestigated. ➤ Oncology nurses can take the lead in addressing these issues by conducting comprehensive pain and symptom assessments of cancer survivors who are at increased risk for long-term and late effects from cancer and its treatment, including pain. Purpose/Objectives: To describe the most common side effects associated with the use of opioid treatment in patients with moderate to severe cancer pain; to discuss research findings specific to the use of opioids for cancer pain in long-term cancer survivors. Data Sources: Published research, articles from a literature review, and U.S. statistics. Data Synthesis: Side effects associated with opioid use are a major contributor to patient reluctance to follow treatment plans for cancer pain. Clinicians must follow the critical steps necessary to build comprehensive treatment plans that include a preventive approach to side effects and opioid rotation when side effects do not resolve. Conclusions: Side effects associated with long-term use of opioids by cancer survivors are a major contributor to patient reluctance to follow a cancer pain treatment plan. Patient education efforts must promote open and clear communication between survivors and their providers about side effects and other important issues related to long-term use of opioids in managing pain related to cancer and its treatment. Implications for Nursing: Oncology nurses recognize that patients often require the long-term use of opioids when they experience chronic pain as a result of their disease or its treatment. The long-term physical and cognitive effects of such opioid use are not well known, despite the advances that have been made in cancer pain control and research. Survivors should communicate their concerns about side effects to the treatment team. In addition, patients and family members must be encouraged to inform their providers about personal attitudes, beliefs, and practices that may affect decisions about taking their analgesics as prescribed. Most importantly, oncology nurses must teach patients and their families to self-advocate for optimal pain relief with minimal side effects.
Dignitas , 2022
Palliative care (PC) has the ability to enhance quality of life for people who are diagnosed with a life-limiting, serious illness. However, there are populations whose experience of PC may not measure up to the standard of care that most palliative patients receive. Individuals with substance use disorders (SUD) often encounter barriers to optimal care. The World Health Organization (WHO) defines SUDs as “a group of conditions related to alcohol or other drug use,” all of which include the use of psychotropic substances that may or may not have been prescribed clinically.[i] These include alcohol, opioids, cannabinoids, sedatives, hallucinogens, cocaine, and other stimulants such as tobacco. This paper will focus on more stigmatized SUDs related to alcohol, opioids, and illicit substances, as many PC programs do not have adequate knowledge on how to care for these individuals and their unique concerns. This paper will examine common barriers to PC in the general population and discuss those exclusive to those with an SUD. Recommendations on improving access to PC for both populations are also discussed.