Cancer pain management

Pain is one of the most prevalent consequences of cancer affecting up to 70% of all patients with cancer over the course of their disease. Despite several treatment options and best practice guidelines, under treatment of cancer-related pain is widely reported; up to one-third of patients do not receive analgesia proportional to their pain intensity.Adopting best practices in cancer pain management (CPM) is particularly challenging in resource-limited settings. Inadequate availability of and access to opioid analgesics, the cornerstone for treating cancer pain, are also major challenges in resource-limited settings where many patients are first diagnosed with advanced-stage cancer; Supplementary resource. Global consumption of opioid analgesics is predominantly driven by high-income countries, whereas 75% of the world population, mainly in lower - and middle-income countries, lack of adequate access to pain relief. Impediments to opioid availability and accessibility in resource-limited settings include restrictive opioid formularies, over-regulation related to licensing and prescription, fear of opioid diversion to illicit channels, issues related to supply and distribution, cultural attitudes towards pain, patients and healthcare provider (HCP) concerns over addiction, and restricted financial resources.Thus, there remains a significant gap between optimal practice and actual practice in CPM in resource-limited settings. While several international guidelines provide recommendations on managing cancer pain, these are often predicated on maximal resource availability and cannot be easily and appropriately implemented in areas of resource scarcity. Clinical guidelines also provide little information and guidance on how to translate evidence-based recommendations into clinical practice. Additionally, several diverse factors influence the implementation of best practice guidelines (Fig. 1).Especially in palliative care for advanced disease, lack of education of HCPs, policymakers, and patients continues to be a key limiting factor contributing to inadequate CPM. This may manifest itself as misconceptions (including Opiophobia), improper use of analgesics, and restrictive policies governing availability and accessibility of analgesicsAs a step towards ensuring the provision of optimal CPM across all settings, a multinational consortium—the Cancer Pain management in Resource-limited settings (CAPER) Working Group (WG)—proposes a two-part, expert-driven initiative. We favor the use of the term resource-limited settings rather than countries/regions to underscore the heterogeneity of resource availability even within a country/region. The ultimate goal of this initiative is to facilitate high-quality care based on adaptations of evidence-based guidelines to improve pain-related clinical outcomes for all patients with cancer pain. This paper details the CAPER WG initiative emphasizing the collaborative process undertaken in providing physicians with practical evidence-based algorithms for optimizing CPM amidst limited availability of analgesics and a recommended implementation framework through education and advocacy that can be carried out by any groups or institutions to improve the availability and accessibility of opioids in resource-limited settings

Keywords:

Palliative care , cancer pain Fig. 1 Factors influencing the implementation of guidelines for cancer pain management