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      Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

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          Abstract

          Introduction

          A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer.

          Methods

          The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4.

          Results

          This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction.

          Conclusion

          These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40122-021-00248-x.

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          Most cited references28

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          Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC.

          Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and consensus recommendations were created by formal international expert panel. The content of the guidelines was defined according to several topics, each of which was assigned to collaborators who developed systematic literature reviews with a common methodology. The recommendations were developed by a writing committee that combined the evidence derived from the systematic reviews with the panellists' evaluations in a co-authored process, and were endorsed by the EAPC Board of Directors. The guidelines are presented as a list of 16 evidence-based recommendations developed according to the Grading of Recommendations Assessment, Development and Evaluation system. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis.

            Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade.
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              Optimal pain management for patients with cancer in the modern era

              Pain is a common symptom amongst patients with cancer. Adequate pain assessment and management is critical to improve the quality of life and health outcomes in this population. In this review we provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder and considerations when managing pain in a survivorship population.
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                Author and article information

                Contributors
                filomena.puntillo@uniba.it
                Journal
                Pain Ther
                Pain Ther
                Pain and Therapy
                Springer Healthcare (Cheshire )
                2193-8237
                2193-651X
                17 March 2021
                17 March 2021
                June 2021
                : 10
                : 1
                : 605-617
                Affiliations
                [1 ]Paolo Procacci Foundation, Rome, Italy
                [2 ]GRID grid.7841.a, Department of Medical and Surgical Sciences and Biotechnologies, , Sapienza University of Rome, ; Latina, Italy
                [3 ]GRID grid.18887.3e, ISNI 0000000417581884, Anesthesiology, Intensive Care, and Pain Medicine Unit, , Sant’Andrea University Hospital, ; Rome, Italy
                [4 ]Pain Medicine Unit, Istituto Europeo Oncologico, Milan, Italy
                [5 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Department of Interdisciplinary Medicine (DIM), , University of Bari; Anesthesia, Intensive Care and Pain Unit, Policlinico Hospital, ; 70124 Bari, Italy
                [6 ]GRID grid.11450.31, ISNI 0000 0001 2097 9138, Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, , University of Sassari, ; Sassari, Italy
                [7 ]GRID grid.8404.8, ISNI 0000 0004 1757 2304, University of Florence, Pain and Palliative Care Clinic, Careggi Hospital, ; 50139 Florence, Italy
                Author information
                http://orcid.org/0000-0001-7274-6467
                Article
                248
                10.1007/s40122-021-00248-x
                8119556
                33730338
                ba000ba7-c758-44ed-b276-cc0294ba6cdf
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 22 December 2020
                : 15 February 2021
                Funding
                Funded by: Paolo Procacci Foundation
                Funded by: Molteni & C Dei Fratelli Alitti
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2021

                breakthrough pain,cancer pain,opioids,opioid-induced bowel dysfunction (oibd),opioid-induced constipation (oic)

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