As the prevalence of cancer rises internationally, pain continues to remain the commonest symptom of cancer at diagnosis, with 55% of all cancer patients experiencing pain of moderate or severe intensity and 66% experiencing pain as they approach death. Additionally, over a third of cancer survivors suffer chronic pain. Chronic cancer-related pain is defined as chronic pain caused by the primary cancer itself or metastasis (chronic cancer pain) or its treatment (chronic post-cancer treatment pain). This session will describe the new International Association for the Study of Pain classification of chronic cancer pain for ICD-11 and discuss the clinical challenges posed by the longer-term pain management in cancer patients and survivors.
The challenge for practitioners remains as to how best to address the current opioid epidemic without restricting access for cancer pain control. The Centre for Disease Control reports a rapid rise in opioid prescriptions per capita and the average dose prescribed for cancer pain. We will review current contributors to the opioid epidemic in chronic cancer pain management. These include the lack of a standardised taxonomy for the classification of cancer-related pain and a limited consideration for a mechanistic approach to pain management. Additionally, clinicians demonstrate a poor understanding of opioid pharmacokinetics and other alternatives for pain control and fail to pursue an integrated approach to concurrently treat chronic pain with opioids in a structured, safe, and supportive environment.