Pain: Common Side Effect
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain can be acute or chronic. Syndromes include neuropathic pain, chronic pain syndromes, arthralgias, skeletal pain, and gastrointestinal, genitourinary, and pelvic pain. Pain occurs in 59% of patients undergoing treatment and almost 100% of those with advanced disease.
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For pain, standards of care are based on established evidence-based practice.
Definition
• Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain can be acute or chronic. Syndromes include neuropathic pain, chronic pain syndromes, arthralgias, skeletal pain, and gastrointestinal, genitourinary, and pelvic pain.
Incidence
• Pain occurs in 59% of patients undergoing treatment and almost 100% of those with advanced disease.
Assessment Tools and Recommended Intervals
• Perform a patient history.
• Assess pain on a scale of 1 (no pain) to 10 (worst pain).
• Perform a physical examination.
Prevention Measures
• Avoid injury and the source of pain.
Evidence-Based Interventions and Management
• Consider recommending the following:
• Opioids
• Adjuvant analgesics
• Nonsteroidal anti-inflammatory drugs
• Muscle relaxers
• Topic analgesics
• Antidepressants
• Psychological and psychosocial treatment
• Physical therapy
• Acupressure or acupuncture
• Hands-on treatment
• Local treatment
• Surgery
• Other (e.g., pain management service, physical medicine and rehabilitation, mental health providers, 0ncology specialist [gynecology oncologist, oncology urologist], palliative care)
Agents and Interventions to Avoid
• Avoid overprescribing and highly addictive medications. Prescribe at the lowest effective dose for the shortest time period.
• When prescribing pain medication, also prescribe treatment for constipation.
• When stopping opioids, slowly reduce the dose and timing to avoid withdrawal symptoms.
Evidence-Based Resources for Providers
• NCCN Clinical Practice Guidelines in Oncology: Survivorship (v.3.2021) (www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf)
• Oncology Nursing Society Putting Evidence Into Practice: Chronic pain (www.ons.org/pep/chronic-pain)
Evidence-Based Resources for Patients and Family
• NCCN Guidelines for Patients: Survivorship Care for Cancer-Related Late and Long-Term Effects (www.nccn.org/patients/guidelines/content/PDF/survivorship-crl-patient.p…)
About the Author(s)
Suzanne M. Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, is a professor in the Department of Internal Medicine in the Division of Hematology/Oncology and in the Trudy Busch Valentine School of Nursing at Saint Louis University in Missouri and Ellen Carr, PhD, RN, AOCN®, is the editor of the Clinical Journal of Oncology Nursing at the Oncology Nursing Society in Pittsburgh, PA. The authors take full responsibility for this content. The article has been reviewed by independent peer reviewers to ensure that it is objective and free from bias. Mahon can be reached at suzanne.mahon@health.slu.edu, with copy to CJONEditor@ons.org. (Submitted June 2021. Accepted August 26, 2021.)