In an article published online last week in JAMA Oncology, writers from the University of Pennsylvania School of Nursing and the Perelman School of Medicine warn that clinical guidelines developed in the face of the opioid abuse and misuse crisis are likely confounding efforts to treat chronic cancer related pain. Lead author Salimah H. Meghani, PhD, MBE, RN, FAAN, Associate Professor of Nursing and Term Chair of Palliative Care at the University of Pennsylvania School of Nursing (Penn Nursing), and coauthor, Neha Vapiwala, MD, Associate Professor of Radiation Oncology and Vice Chair for Education in the Perelman School of Medicine at the University of Pennsylvania (PSOM), urge that guideline-producing agencies, including the CDC and others work to resolve inconsistencies between their recommendations and those of the National Comprehensive Care Network (NCCN). The authors write that “Competing contemporary guidelines from diverse authoritative agencies and organizations carry the potential to confuse, if not seriously jeopardize, pain management for patients with cancer who are living with moderate to severe pain, adding to an already appalling burden of unrelieved cancer pain.”
Drs. Meghani and Vapiwala observe that although CDC guidelines exclude patients with cancer, they apply to those who have completed cancer treatment, even though similar levels of chronic pain have been observed in both populations. The CDC also advocates for avoidance of long-acting opioids, even though NCCN guidelines recommend coadministration of long- and short-acting opioids to better manage pain flares. Additionally, the authors contend that CDC promotion of nonopioid and nonpharmacologic modalities for chronic pain is not supported by empirical evidence of effectiveness. Dr. Meghani contends that “Many of the current recommendations around opioid prescribing practices stem from expert consensus rather than empirical research, which is urgently needed to generate and develop informed guidelines for patients with chronic cancer-related pain.”
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An additional patient perspective on the issue may be read here.
The journal abstract may be found here.
Posted on June 2, 2018