Orchestrating Care of Cancer Pain in GP Practice
Thank you for choosing to update your knowledge on the central role of GP’s in assessing and managing patients with cancer pain. Despite progress in cancer treatments, cancer pain remains underestimated, poorly assessed, and undertreated, particularly in the most severe cases. This online CPD activity will assist GPs take the clinical lead in the assessment and management of cancer pain.
This activity will take approximately 30 minutes to complete and can be completed at your own pace over a number of sessions.
Identify patient barriers to the management of cancer pain
Address patient/carer barriers to opioid use in cancer pain
Develop and implement a multimodal pain management plan
Take the clinical lead in coordinating multidisciplinary cancer pain management
Time to complete: 30 minutes
RACGP CPD activity: 1 CPD activity point
Opioids are only to be used after other modalities have failed or are not appropriate, and only in carefully selected patients.
Opioids should only be prescribed as a component of comprehensive multidisciplinary and multimodal pain management.
When considering an opioid for your patients with chronic severe pain, it is important to consider the side effects and potential risks, as well as the benefits of treatment.
1. Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O'Brien T, Mercadante S, et al. Standards for the management of cancer-related pain across Europe-a position paper from the EFIC task force on cancer pain. Eur J Pain. 2019;23:660-668
2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Adult cancer pain, verion 1 2020. 2020
3. Lovell M, Boyle F. Cancer pain management. Medicine Today 2010;11:33-38
4. George B, Minello C, Allano G, Maindet C, Burnod A, Lemaire A. Opioids in cancer-related pain: Current situation and outlook. Support Care Cancer. 2019;27:3105-3118
5. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage. 2016;51:1070-1090 e1079
6. Palliative Care Expert Group. Therapeutic Guidelines Palliative Care, Therapeutic Guidelines Complete, March 2020 online edition.: Therapeutic Guidelines Limited; 2016.
7. Mehta A CL. Understanding of the concept of ‘‘total pain’’. Journal of Hospice and Palliative Nursing. 2008;10:26-32
8. Portenoy RK DL. Overview of cancer pain syndromes. UpToDate. 2019
9. Dalal S, Bruera E. Pain management for patients with advanced cancer in the opioid epidemic era. Am Soc Clin Oncol Educ Book. 2019;39:24-35
10. Clark K. Care at the very end-of-life: Dying cancer patients and their chosen family's needs. Cancers (Basel). 2017;9
11. Glare P, Ikemoto T. Managing pain in cancer survivors. Pain Management Today. 2018;5:17-22
12. Gunnarsdottir S, Sigurdardottir V, Kloke M, Radbruch L, Sabatowski R, Kaasa S, et al. A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer. 2017;25:3595-3602
13. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. Pain Med. 2005;6:107-112
14. Katelaris P, Krassas G. The clinical challenge of opioid-induced constipation: Insights from the opioid-induced constipation clinical audit. J Gen Prac. 2016;4:1-5
15. Analgesic Expert Group. Therapeutic Guidelines Analgesic, Therapeutic Guidelines Complete, March 2020 online edition.: Therapeutic Guidelines Limited; 2012.
16. Schug S, Pogatzki-Zhan E. Chronic pain after surgery or injury. Pain Clinical Updates. 2011;XIX(1):1-5
17. Therapeutic Goods Administration. Prescription opioids: Information for consumers, patients and carers. 2020 [accessed 28 December 2020]. Available from: https://www.tga.gov.au/prescription-opioids-information-consumers-patients-and-carers
18. White A. Safe and effective use of opioids in patients with advanced cancer. Pain Management Today. 2016;3:24-28
19. Australian Medicines Handbook online. Available from: https://amhonline.amh.net.au.
20. Targin modified release tablets product information. 2020
21. Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists. Opioid dose equivalence. 2019
22. Paice JA. Navigating cancer pain management in the midst of the opioid epidemic. Oncology (Williston Park). 2018;32:386-390, 403
23. Gaertner J, Boehlke C, Simone CB, 2nd, Hui D. Early palliative care and the opioid crisis: Ten pragmatic steps towards a more rational use of opioids. Ann Palliat Med. 2019;8:490-497
24. Ward J, Vogelzang N, Davis B. Initial management of regionally localized intermediate-, high-, and very high-risk prostate cancer. UpToDate. 2020
25. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005;6:432-442
26. Morris L, Gorayski P, Turner S. Back pain in a cancer patient: A case study. Aust Fam Physician. 2014;43:529-530
27. Chan BK, Tam LK, Wat CY, Chung YF, Tsui SL, Cheung CW. Opioids in chronic non-cancer pain. Expert Opin Pharmacother. 2011;12:705-720
28. Kahan M, Mailis-Gagnon A, Wilson L, Srivastava A, National Opioid Use Guideline G. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 1: General population. Can Fam Physician. 2011;57:1257-1266, e1407-1218
29. Sartor A, DiBiase S. Bone metastases in advanced prostate cancer: Clinical manifestations and diagnosis. . UpToDate. 2020
30. Ahmedzai SH, Leppert W, Janecki M, Pakosz A, Lomax M, Duerr H, et al. Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain. Support Care Cancer. 2015;23:823-830
31. Ahmedzai SH, Nauck F, Bar-Sela G, Bosse B, Leyendecker P, Hopp M. A randomized, double-blind, active-controlled, double-dummy, parallel-group study to determine the safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate/severe, chronic cancer pain. Palliat Med. 2012;26:50-60
32. Sze W, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: Single fraction versus multifraction radiotherapy. Cochrane Database of Systematic Reviews 2002