Chronic and Refractory Pain: A Systematic Review of Pharmacologic Management in Oncology

Jeannine M. Brant, PhD, APRN, AOCN®, FAAN; Lisa Keller, RN, OCN®, MS; Karen McLeod, MSN, RN, OCN®, CNL; Chao Yeh, PhD, RN; Linda H. Eaton, PhD, RN, AOCN®


Background: Chronic and refractory cancer pain are significant issues and can increase patient suffering and compromise quality of life. A variety of evidence-based pharmacologic strategies can be used routinely to control cancer pain. 

Objectives: The purpose of this study is to conduct a systematic review of the pharmacologic evidence in the management of chronic and refractory cancer pain. 

Methods: The Oncology Nursing Society’s Putting Evidence Into Practice pain team conducted a search of 184 systematic reviews, meta-analyses, research studies, and guidelines and classified the evidence into weight-of-evidence categories. 

Findings: Opioids are the mainstay of cancer pain management, but evidence supports the use of coanalgesics and adjuvants to improve overall pain management. Complementary pharmacologic strategies, such as caffeine and herbal preparations, are under investigation, but additional research is needed to recommend these modalities.

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