Chronic Cancer Pain Management: A New Dilemma

Thursday, May 2, 2013

As Long-Term Cancer Survival Rates Increase, So Do the Consequences of Prolonged Opioid Therapy.

As  cancer survival improves, the number of cancer patients with chronic pain — as distinct from acute or terminal pain — increases. There are a number of reasons patients with cancer experience chronic pain, related either to the disease itself or its treatment. Chronic pain following cancer is a distinct disease entity, and patients present a unique challenge in terms of pain management.

Opioids remain the mainstay of cancer pain management, but the long-term consequences of tolerance, dependency, hyperalgesia and suppression of the hypothalamic/pituitary axis should be acknowledged and managed. Because of these patients’ cancer diagnoses, treating them with escalated opioid usage and dose levels has long been justifiable.

As long-term survivals increase, these patients are susceptible to all the pitfalls of long-term opioid treatment. With this new challenge, oncologists need to incorporate the principles of chronic opioid pain management into their practices so that patients are not harmed by unrecognized complications of long-term opioid therapy.

Pain Report #14 Cancer Pain: Etiology, Barriers, Assessment, and Treatment is an online article designed to bridge the gap in knowledge of cancer pain management by providing an overview of chronic pain in cancer patients while focusing on assessment, treatment, reassessment and barriers to effective treatment. The article is supported by an educational grant by Purdue Pharma, L.P., and written by Paul J. Christo, M.D., M.B.A, associate professor at The Johns Hopkins University School of Medicine. This free, current, online continuing medical education (CME) offering explores this issue, offers AMA PRA Category 1 Credit and is intended for physicians, physician assistants, registered nurses, nurse practitioners and pharmacists. It is available at

Dannemiller Inc. began in 1984 as the Dannemiller Memorial Educational Foundation in San Antonio, where it remains today. Widely known for its annual anesthesiology and pain management review courses, Dannemiller has grown to become a leader in CME. The company annually accredits more than 250 medical education programs and provides more than 50,000 credit hours in a wide variety of therapeutic categories. In 2006, the Accreditation Council for Continuing Medical Education (ACCME) awarded Dannemiller Accreditation with Commendation, a full six-year accreditation that is the highest level awarded by the ACCME. Dannemiller is one of only 18 accredited providers for the American Association of Nurse Practitioners, the California Board of Registered Nursing and the Accreditation Council for Pharmacy Education. Its flagship website,, has been in existence more than 15 years, with multiple commercial supporters and CME activities. The current number of registered users is well over 62,400. In 2012, more than 88,700 certificates were issued through the website.

Today Dannemiller continues to expand its offering to a wide range of specialties in the medical community. The company’s educational offerings encompass a multitude of delivery modalities, including one-hour to multiday onsite and regional courses — featuring live lectures and hands-on demonstrations; interactive, computer-based simulations; role playing and case studies; online articles, abstracts, monographs, case studies, slideshows and webinars; portable media for iPod, iPad, DVD and USB; and a variety of online testing databases.