The utilization of medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) may provide symptomatic relief to the point that the total daily dose of opioids could be reduced.5
Neuropathic pain can potentially be treated with non-opioids such as pregabalin, gabapentin, or tricyclic antidepressants.
Before starting any medication, it is important to take into consideration the patient’s overall health and organ function.
For example, acetaminophen may not be the best choice in a patient with significant liver involvement and NSAIDs may need to be avoided in patients with renal and/or platelet dysfunction.
Opioid-sparing medications may be useful in certain scenarios, however some non-opioids still carry the risk for dependence. Medications such as tramadol and pregabalin are still classified as controlled substances, so there is a potential for dependence.
If a health care practitioner does not feel comfortable managing a patient’s opioid medications, they can also consider discussing the case with different consultations.
Palliative care and pain management consultation groups are potentially available in the inpatient and outpatient setting.
Physicians from these groups may have more experience in managing opioids and developing a pain treatment plan specifically aimed at reducing the risk for opioid dependence as much as possible.
If there is a localized source of pain, then interventional procedures may provide local relief. For example, patients with pancreatic cancer with extensive celiac nerve involvement may be candidates for endoscopic ultrasound (EUS)-guided nerve blocks.
As with any treatment, the risks and benefits of any interventional procedure should be weighed prior to full consideration.
- Teunissen SC, Wesker W, Kruitwagen C, et al. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007;34(1):94-104.
- Greco MT, Roberto A, Corli O, et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32(36):4149-4154.
- Miaskowski C. The use of risk-management approaches to protect patients with cancer-related pain and their healthcare providers. Oncol Nurs Forum. 2008;35 Suppl:20-4.
- Bruera E, Paice JA. Cancer pain management: safe and effective use of opioids. Am Soc Clin Oncol Educ Book. 2015;35:e593-e599.
- Portenoy RK. Treatment of cancer pain. Lancet. 2011;377(9784):2236-2247.