COMMENTARY

Cancer vs Noncancer Pain: Time to Shed the Distinction?

Charles E. Argoff, MD

Disclosures

July 23, 2013

In This Article

A Universal Approach

There are many permutations that have to be considered, and so it's extremely important to take a universal approach to the safest and most effective ways of helping people and recognize that some of the guidance we receive, and some of the medicines that are available for so-called cancer-related pain, may not have been studied in individuals who had active cancer. People may have pain related to an effect of their cancer, although they don't have active cancer. We aren't dealing with the kind of specificity and sensitivity that might be possible when treating patients with specific diseases, when we can target and pick treatments for a specific process. By using strict categories, such as "cancer-related" and "non-cancer related," we suggest that we can do the same with pain, when in fact our understanding of those processes may be very blurred.

I would like to suggest that we continue to take care of people as effectively and safely as possible, and that we focus on reducing barriers to the most effective treatment for our patients. We should evaluate our patient's past, including cancer and non-cancer-related history; review the best available literature and information about what is best for those groups; and keep in mind that some of the studies of "cancer-related pain" may have been in individuals who don't have active cancer. We need to realize that we still have significant barriers to pain management, and that this dichotomy is not helping at all; it's only increasing those barriers. We need to address healthcare professional-related concerns about managing people with pain.

Most clinicians still don't have adequate training. Training people to think about cancer vs noncancer pain is not, in my opinion, going to help them understand the important concepts of helping all people in as safe and effective a manner as possible.

Approaching somebody with cancer-related pain as if they are somehow "above" the concerns that we would have for a patient with non-cancer-related pain with respect to opioid or other analgesic prescribing (concerns about misuse, abuse, not adhering to the regimen appropriately, seeing multiple practitioners, receiving duplications of therapy, etc.) is not appropriate. It is not appropriate to think that because a patient has a diagnosis of active cancer or a history of cancer, that we shouldn't have the same concerns about making sure that we are prescribing as safely as possible from our point of view. We should still try to reduce the abuse, misuse, and diversion of medications and address a patient's history of substance abuse, whether or not the patient has a diagnosis of cancer. We should address these concerns in a universal way, so that we are treating individuals and not categories, such as "cancer" or "noncancer," that have no solid foundation or evidence base for being separate categories. That is really important.

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