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Evidence-Based Standards for Cancer Pain Management

Sydney M. Dy, Steven M. Asch, Arash Naeim, Homayoon Sanati, Anne Walling, Karl A. Lorenz

From Johns Hopkins University, Baltimore, MD; Veterans Affairs Greater Los Angeles Healthcare System; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles; RAND Health, Santa Monica; and University of California, Irvine, Irvine, CA

Corresponding author: Sydney M. Dy, MD, MSc, Health Policy and Management, Oncology, and Medicine, Johns Hopkins University, Room 609, 624 N Broadway, Baltimore, MD 21205; e-mail: sdy{at}jhsph.edu

High-quality management of cancer pain depends on evidence-based standards for screening, assessment, treatment, and follow-up for general cancer pain and specific pain syndromes. We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Providers should routinely screen for the presence or absence and intensity of pain and should perform descriptive pain assessment for patients with a positive screen, including assessment for likely etiology and functional impairment. For treatment, providers should provide pain education, offer breakthrough opioids in patients receiving long-acting formulations, offer bowel regimens in patients receiving opioids chronically, and ensure continuity of opioid doses across health care settings. Providers should also follow up on patients after treatment for pain. For metastatic bone pain, providers should offer single-fraction radiotherapy as an option when offering radiation, unless there is a contraindication. When spinal cord compression is suspected, providers should treat with corticosteroids and evaluate with whole-spine magnetic resonance imaging scan or myelography as soon as possible but within 24 hours. Providers should initiate definitive treatment (radiotherapy or surgical decompression) within 24 hours for diagnosed cord compression and should follow up on patients after treatment. These standards provide an initial framework for high-quality evidence-based management of general cancer pain and pain syndromes.

Supported by a grant from Amgen Inc to the RAND Corporation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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