Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

Effects of Opioids in Cancer Pain: An Interplay Among Genetic Factors, Immune Response, and Clinical Outcomes-A Scoping Review

Background/Objectives: Managing cancer-related pain presents complex challenges involving the interplay between analgesic efficacy, immune system responses, and patient outcomes. Methods: Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we conducted a comprehensive literature search in Medline, Scopus, and Web of Science databases. The review synthesized evidence regarding opioid pain management modalities, genetic variations affecting pain perception, and associated drug metabolism. Results: The literature reveals significant associations between opioid administration and immune function, with potential implications for cancer progression and survival. Genetic polymorphisms in key genes influence individual responses to pain opioid metabolism and, finally, pain management strategies. The immunosuppressive effects of opioids emerge as a critical consideration in cancer pain management, potentially influencing disease progression and treatment outcomes. Conclusions: Genetic variants influence analgesic efficacy, while the interaction between opioid-induced immunosuppression and genetic factors impacts both pain control and survival outcomes. This emphasizes the need for personalized treatment approaches considering individual genetic profiles and immune function.

Multimodal Interprofessional Adult Cancer Pain Management: An Integrative Review

PROBLEM IDENTIFICATION

Poorly controlled cancer pain leads to increased morbidity and decreased quality of life. This integrative review aims to strengthen cancer pain management practices by identifying the effectiveness of multimodal interprofessional pain management (MIPM) in treating cancer pain, current MIPM practices, and barriers and facilitators to implementation.

METHODS

The following three databases were searched for literature exploring MIPM in the oncologic setting: PubMed®, CINAHL®, and Embase®.

DATA EVALUATION

This integrative review included 16 articles published from 2013 to 2023 that explored the use of MIPM in adult patients with cancer.

SYNTHESIS

Adult patients with cancer receiving MIPM reported reduced pain intensity or interference. With MIPM, the number of patients reporting moderate to severe pain or undertreated pain decreased, and the number of patients reporting adequate pain management increased. In addition, patients receiving MIPM reported improvements in physical and psychosocial cancer-related symptoms.

IMPLICATIONS FOR NURSING

The components of MIPM are recommended to be used in conjunction with each other for optimal patient outcomes. To optimize the use of MIPM, improving provider knowledge and interprofessional care coordination and communication is warranted.

Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits

Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.