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20-02-2017 | Cancer pain | Article

Multidimensional Treatment of Cancer Pain

Journal: Current Oncology Reports

Authors: Weiyang Christopher Liu, Zhong Xi Zheng, Kian Hian Tan, Gregory J. Meredith

Publisher: Springer US

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Abstract

Purpose of review

Though numerous treatment options are available to address cancer pain, inadequate management continues to be an ongoing problem worldwide.

Recent findings

A systematic review of the recent scientific literature was conducted with attention to new therapies along with reports of general consensus that were analyzed.

Summary

Pain research continues to be difficult and though numerous guidelines have been developed, adequate powered studies are not common. Good practice would suggest a comprehensive approach to cancer pain management taking into account the many options available and treating each patient with a personalized therapeutic program. Though there is a very low number of randomized control trials, this probably reflects the difficulty in conducting these studies in heterogeneous cancer pain patient populations in sufficient numbers to yield credible study power.
Literature
1.
IASP. 2008–2009 Global Year Against Cancer Pain IASP; 2008 [Available from: https://​www.​iasp-pain.​org/​GlobalYear/​CancerPain.
2.
•• van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070–90 e9. Not only an excellent review and discussion of cancer pain prevalence but notes progress or lack thereof since previous report in 2007. CrossRef
3.
Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.CrossRefPubMed
4.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.CrossRefPubMed
5.
University of Wisconsin-Madison PPS, Group. Opioid Consumption Data 2013 [Available from: http://​www.​painpolicy.​wisc.​edu/​opioid-consumption-data.]
6.
Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer. 2009;17(5):573–9.CrossRefPubMed
7.
• Hui D, Bruera E. A personalized approach to assessing and managing pain in patients with cancer. J Clin Oncol. 2014;32(16):1640–6. A very circumspect discussion of individualize pain assessment. CrossRefPubMedPubMedCentral
8.
Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F, Group EGW. Management of cancer pain: ESMO clinical practice guidelines. Ann Oncol. 2012;23(Suppl 7):vii139–54.CrossRefPubMed
9.
Burton AW, Chai T, Smith LS. Cancer pain assessment. Curr Opin Support Palliat Care. 2014;8(2):112–6.CrossRefPubMed
10.
Daeninck P, Gagnon B, Gallagher R, Henderson JD, Shir Y, Zimmermann C, et al. Canadian recommendations for the management of breakthrough cancer pain. Curr Oncol. 2016;23(2):96–108.CrossRefPubMedPubMedCentral
11.
Abernethy AP, Wheeler JL, Fortner BV. A health economic model of breakthrough pain. Am J Manag Care. 2008;14(5 Suppl 1):S129–40.PubMed
12.
• Caraceni A, Davies A, Poulain P, Cortes-Funes H, Panchal SJ, Fanelli G. Guidelines for the management of breakthrough pain in patients with cancer. J Natl Compr Cancer Netw. 2013;11(Suppl 1):S29–36. Recommendations for management of unresolved cancer pain.
13.
Davies A, Zeppetella G, Andersen S, Damkier A, Vejlgaard T, Nauck F, et al. Multi-Centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain. 2011;15(7):756–63. Guidelines and discussion of barriers to treatment of break through cancer pain CrossRefPubMed
14.
Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA. Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manag. 2010;6(2):97–108. Discussion of incidence of cancer pain CrossRefPubMed
15.
Davies AN, Dickman A, Reid C, Stevens AM, Zeppetella G. Science Committee of the Association for palliative medicine of great B, et al. the management of cancer-related breakthrough pain: recommendations of a task group of the science Committee of the Association for palliative medicine of great Britain and Ireland. Eur J Pain. 2009;13(4):331–8.CrossRefPubMed
16.
Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson LE, Fisher K, et al. The Alberta breakthrough pain assessment tool for cancer patients: a validation study using a delphi process and patient think-aloud interviews. J Pain Symptom Manag. 2008;35(2):136–52.CrossRef
17.
Webber K, Davies AN, Zeppetella G, Cowie MR. Development and validation of the breakthrough pain assessment tool (BAT) in cancer patients. J Pain Symptom Manag. 2014;48(4):619–31.CrossRef
18.
Sperlinga R, Campagna S, Berruti A, Laciura P, Ginosa I, Paoletti S, et al. Alberta breakthrough pain assessment tool: a validation multicentre study in cancer patients with breakthrough pain. Eur J Pain. 2015;19(7):881–8.CrossRefPubMed
19.
McCracken K. James Logan prize essay. The challenges of cancer pain assessment. Ulster Med J. 2015;84(1):55–7.PubMedPubMedCentral
20.
Kress HG, Aldington D, Alon E, Coaccioli S, Collett B, Coluzzi F, Huygen G, Jaksch W, Kalso E, Kocot-Kepska M, Mangas AC, Ferri CM, Mavrocordatos P, Morlion B, Muller-Schwefe G, Nicolaou A, Hernandez CP, Sichere P. A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr Med Res Opin. 2015;31(9):1743–54.CrossRefPubMed
21.
Borneman T, Koczywas M, Cristea M, Reckamp K, Sun V, Ferrell B. An interdisciplinary care approach for integration of palliative care in lung cancer. Clin Lung Cancer. 2008;9(6):352–60.CrossRefPubMed
22.
Dy SM, Asch SM, Naeim A. Evidence-based standards for cancer pain management. J Clin Oncol. 2008;26:3879–85.CrossRefPubMed
23.
Portenoy RK. Treatment of cancer pain. Lancet. 2011;377:2236–47.CrossRefPubMed
24.
Hu C, Zhang H, Wu W, Yu W, Li Y, Bai J, Luo B, Li S. Acupuncture for pain Management in Cancer: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2016;2016:1720239. doi:10.​1155/​2016/​1720239.PubMedPubMedCentral
25.
Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. Eur J Cancer Care (Engl). 2016.
26.
Boyd C, Crawford C, Paat CF, Price A, Xenakis L, Zhang W. The impact of massage therapy on function in pain populations-a systematic review and meta-analysis of randomized controlled trials: part II, cancer pain populations. Evidence for massage therapy (EMT) working group. Pain Med. 2016;17(8):1553–68.CrossRefPubMedPubMedCentral
27.
Lee SH, Kim JY, Yeo S, Kim SH, Lim S. Meta-analysis of massage therapy on cancer pain. Integr Cancer Ther. 2015;14(4):297–304. doi:10.​1177/​1534735415572885​.CrossRefPubMed
28.
Keenan A, Keithley JK. zer Pain in Adults. Oncol Nurs Forum. 2015;42(6):E368–75.CrossRefPubMed
29.
• Lovell MR, Luckett T, Boyle FM, Phillips J, Agar M, Davidson PM. Patient education, coaching, and self-management for cancer pain. J Clin Oncol. 2014;32(16):1712–20. Discussion of education in cancer patients, which is often overlooked. CrossRefPubMed
30.
Prevost V, Delorme C, Grach MC, Chvetzoff G, Hureau M. Therapeutic education in improving cancer pain management: a synthesis of available studies. Am J Hosp Palliat Care. 2016;33(6):599–612.CrossRefPubMed
31.
Lee YJ, Hyun MK, Jung YJ, Kang MJ, Keam B, Go SJ. Effectiveness of education interventions for the management of cancer pain: a systematic review. Asian Pac J Cancer Prev. 2014;15(12):4787–93.CrossRefPubMed
32.
Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41–9.CrossRefPubMedPubMedCentral
33.
Belfer I, Schreiber KL, Shaffer JR, Shnol H, Blaney K, Morando A, et al. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain. 2013;14(10):1185–95.CrossRefPubMed
34.
Schreiber KL, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain. 2013;154(5):660–8.CrossRefPubMed
35.
Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manag. 2002;24(5):526–42.CrossRef
36.
Gauthier LR, Rodin G, Zimmermann C, Warr D, Librach SL, Moore M, et al. The communal coping model and cancer pain: the roles of catastrophizing and attachment style. J Pain. 2012;13(12):1258–68.CrossRefPubMed
37.
Novy DM, Aigner CJ. The biopsychosocial model in cancer pain. Curr Opin Support Palliat Care. 2014;8(2):117–23.CrossRefPubMed
38.
Williams ACDC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews. 2012(11).
39.
Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012;30(5):539–47.CrossRefPubMed
40.
Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S. Patient-related barriers to pain management: the barriers questionnaire II (BQ-II). Pain. 2002;99(3):385–96.CrossRefPubMed
41.
Miaskowski C, Dodd MJ, West C, Paul SM, Tripathy D, Koo P, et al. Lack of adherence with the analgesic regimen: a significant barrier to effective cancer pain management. J Clin Oncol. 2001;19(23):4275–9.CrossRefPubMed
42.
Bennett MI, Bagnall AM, Jose CS. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain. 2009;143(3):192–9.CrossRefPubMed
43.
Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin N Am. 2009;35(2):393–407.CrossRef
44.
Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med. 2006;29(1):17–27.CrossRefPubMed
45.
• Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703–11. A very good review of non-pharmacologic behavioral therapies. CrossRefPubMedPubMedCentral
46.
Montgomery GH, Schnur JB, Kravits K. Hypnosis for cancer care: over 200 years young. CA Cancer J Clin. 2013;63(1):31–44.CrossRefPubMed
47.
Lang EV, Berbaum KS, Faintuch S, Hatsiopoulou O, Halsey N, Li X, et al. Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 2006;126(1–3):155–64.CrossRefPubMedPubMedCentral
48.
Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn. 2002;50(1):17–32.CrossRefPubMed
49.
Butler LD, Koopman C, Neri E, Giese-Davis J, Palesh O, Thorne-Yocam KA, et al. Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychol. 2009;28(5):579–87.CrossRefPubMed
50.
Cramer H, Lauche R, Paul A, Langhorst J, Kummel S, Dobos GJ. Hypnosis in breast cancer care: a systematic review of randomized controlled trials. Integr Cancer Ther. 2015;14(1):5–15.CrossRefPubMed
51.
Anderson KO, Cohen MZ, Mendoza TR, Guo H, Harle MT, Cleeland CS. Brief cognitive-behavioral audiotape interventions for cancer-related pain: immediate but not long-term effectiveness. Cancer. 2006;107(1):207–14.CrossRefPubMed
52.
•• Cheville AL, Basford JR. The role of rehabilitation medicine and the physical agents in the treatment of cancer-associated pain. J Clin Oncol. 2014;32:1691–702. A comprehensive discussion and review of previous works discussing physiotherapy as well as occupational therapy that can be considered to help both pain and functioning in cancer patients. CrossRefPubMed
53.
Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KA, Grond S. Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain. 2001;93(3):247–57.CrossRefPubMed
54.
Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi F. A validation study of the WHO method for cancer pain relief. Cancer. 1987;59(4):850–6.CrossRefPubMed
55.
Miguel R. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control. 2000;7(2):149–56.PubMed
56.
• Vayne-Bossert P, Afsharimani B, Good P, Gray P, Hardy J. Interventional options for the management of refractory cancer pain--what is the evidence? Support Care Cancer. 2016;24(3):1429–38. Another work that notes that there is a dearth of good controlled and adequately powered studies to support many of the interventional procedures commonly employed. CrossRefPubMed
57.
Hucker T, Winter N, Chou J. Challenges and advances in pain Management for the Cancer Patient. Curr Anesthesiol Rep. 2015;5:346–53.CrossRef
58.
Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015;19(4):451–65.CrossRefPubMed
59.
Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711–20.CrossRefPubMedPubMedCentral
60.
Myers J, Chan V, Jarvis V, Walker-Dilks C. Intraspinal techniques for pain management in cancer patients: a systematic review. Support Care Cancer. 2010;18(2):137–49.CrossRefPubMed
61.
Bruera E, Hui D. Spinal analgesia: where is the evidence? Support Care Cancer. 2010;18(10):1237.CrossRefPubMed
62.
Pasutharnchat K, Tan K-H, Hadi MA, Ho K-Y. Intrathecal analgesia in patients with cancer pain–an audit in a tertiary. Ann Acad Med Singap. 2009;38:943–6.PubMed
63.
Bhatnagar S, Gupta M. Evidence-based clinical practice guidelines for interventional pain Management in Cancer Pain. Indian J Palliat Care. 2015;21(2):137–47.CrossRefPubMedPubMedCentral
64.
•• WHO’s cancer pain ladder for adults. World Health Organization website. [Available from: http://​www.​who.​int/​cancer/​palliative/​painladder/​en/​.] The WHO cancer pain recommendations, revised.
65.
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–7. e202-5PubMedPubMedCentral
66.
Ferreira KASL, Kimura M, Teixeira MJ. The WHO analgesic ladder for cancer pain control, twenty years of use: how much pain relief does one get from it? Supp Care Cancer. 2006;14:1086–93.CrossRef
67.
Burton AW, Hamid B. Current challenges in cancer pain management: does the WHO ladder approach still have relevance? Expert Rev Anticancer Ther. 2007;7(11):1501–2.CrossRefPubMed
68.
Paice JA, Von Roenn JH. Under- or overtreatment of pain in the patient with cancer: how to achieve proper balance. J Clin Oncol. 2014;32(16):1721–6. doi:10.​1200/​JCO.​2013.​52.​5196.CrossRefPubMed
69.
Caraceni A, Hanks G, Kaasa S, et al. European palliative care research collaborative (EPCRC); European Association for Palliative Care (EAPC). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13(2):e58–68.CrossRefPubMed
70.
Bandieri E, Romero M, Ripamonti C, et al. A randomized trial of low-dose morphine versus weak opioids in moderate cancer pain. J Clin Oncol. 2016;34:436–42.CrossRefPubMed
71.
Mantyh P. Bone cancer pain: causes, consequences, and therapeutic opportunities. Pain. 2013;154(Suppl 1):S54–62.CrossRefPubMed
72.
Israel FJ, Parker G, Charles M, Reymond L. Lack of benefit from paracetamol (acetaminophen) for palliative cancer patients requiring high-dose strong opioids: a randomized, double-blind, placebo-controlled, crossover trial. J Pain Symptom Manag. 2010;39:548.CrossRef
73.
Nabal M, Librada S, Redondo MJ, et al. The role of paracetamol and nonsteroidal anti-inflammatory drugs in addition to WHO step III opioids in the control of pain in advanced cancer. A systematic review of the literature Palliat Med. 2012;26:305.PubMed
74.
Mercadante S, Giarratano A. The long and winding road of non-steroidal antinflammatory drugs and paracetamol in cancer pain management: a critical review. Crit Rev Oncol Hematol. 2013;87(2):140–5.CrossRefPubMed
75.
Leppert W, Kowalski G. Long-term administration of high doses of transdermal buprenorphine in cancer patients with severe neuropathic pain. Onco Targets Ther. 2015;8:3621–7.CrossRefPubMedPubMedCentral
76.
Pergolizzi JV. Jr1, Mercadante S, Echaburu AV et al. Euromed communications meeting. The role of transdermal buprenorphine in the treatment of cancer pain: an expert panel consensus. Curr Med Res Opin. 2009;25(6):1517–2.CrossRefPubMed
77.
Naing C, Yeoh PN, Aung K. A meta-analysis of efficacy and tolerability of buprenorphine for the relief of cancer pain. Springerplus. 2014;3:87.CrossRefPubMedPubMedCentral
78.
Schmidt-Hansen M, Bromham N, Taubert M, Arnold S, Hilgart JS. Buprenorphine for treating cancer pain. Cochrane Database Syst Rev. 2015;31(3):CD009596.
79.
Leppert W. Tramadol as an analgesic for mild to moderate cancer pain. Pharmacol Rep. 2009;61(6):978–92.CrossRefPubMed
80.
Promme E. Tramadol: does it have a role in cancer pain management? J Opioid Manag. 2005;1(3):131–8.
81.
Hartrick CT, Rozek RJ. Tapentadol in pain management: a μ-opioid receptor agonist and noradrenaline reuptake inhibitor. CNS Drugs. 2011;25(5):359–70.CrossRefPubMed
82.
Raffa RB, Buschmann H, Christoph T, Eichenbaum W, et al. Mechanistic and functional differentiation of tapentadol and tramadol. Expert Opin Pharmacother. July 2012;13(10):1437–49.CrossRefPubMed
83.
Wiffen PJ, Derry S, Naessens K, Bell RF. Oral tapentadol for cancer pain. Cochrane Database Syst Rev. 2015;25(9):CD011460.
84.
Coluzzi F, Raffa RB, Pergolizzi J, et al. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease. J Pain Res. 2015;8:229–38.CrossRefPubMedPubMedCentral
85.
Rosario M, Francesco R, Sergio F et al. Effectiveness of tapentadol prolonged release for the management of painful mucositis in head and neck cancers during intensity modulated radiation therapy. Support Care Cancer. 2016
86.
• Crews KR, Gaedigk A, Dunnenberger HM, et al. Clinical pharmacogenetics implementation consortium guidelines for cytochrome P450 2D6 genotype and codeine therapy: 2014 update. Clin Pharmacol Ther. 2014;95(4):376–82. Recent discussion of how genetics influences the marked individual variable response to codeine. Also applicable to other opioids. CrossRefPubMedPubMedCentral
87.
Bell GC, Donovan KA, McLeod HL. Clinical implications of opioid pharmacogenomics in patients with cancer. Cancer Control. 2015;22(4):426–32.PubMed
88.
Barton MK. First-line low-dose morphine is better for the control of moderate cancer pain than weaker opioids. CA Cancer J Clin. 2016;66(3):177–8.CrossRefPubMed
89.
Bandieri E, Romero M, Ripamonti CI, Artioli F, Sichetti D, Fanizza C, Santini D, Cavanna L, Melotti B, Conte PF, Roila F, Cascinu S, Bruera E, Tognoni G, Luppi M. Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain. J Clin Oncol. 2016;34(5):436–42.CrossRefPubMed
90.
Corli O, Floriani I, Roberto A, Montanari M, Galli F, Greco MT, et al. Are strong opioids equally effective and safe in the treatment of chronic cancer pain? A multicentre randomized phase IV 'real life' trial on the variability of response to opioids. Ann Oncol. 2016;27(6):1107–15.CrossRefPubMed
91.
Schmidt-Hansen M, Bennett MI, Hilgart J. Oxycodone for cancer pain in adult patients. JAMA. 2015;314(12):1282–3.CrossRefPubMed
92.
Holzer P, Ahmedzai SH, Niederle N, Leyendecker P, Hopp M, Bosse B, Spohr I, Reimer K. Opioid-induced bowel dysfunction in cancer-related pain: causes, consequences, and a novel approach for its management. J Opioid Manag. 2009;5(3):145–51.PubMed
93.
Mercadante S, Giarratano A. Combined oral prolonged-release oxycodone and naloxone in chronic pain management. Expert Opin Investig Drugs. 2013;22(1):161–6.CrossRefPubMed
94.
Krashin D, Murinova N, Trescot AM. Extended-release hydrocodone - gift or curse? J Pain Res. 2013;6:53–7.PubMedPubMedCentral
95.
Clemens KE, Likar R. Versatility of different pharmaceutical formulations of hydromorphone in the management of severe cancer pain and pain in palliative care. Pain Manag. 2013;3(5):369–75. doi:10.​2217/​pmt.​13.​26.CrossRefPubMed
96.
Chwieduk CM, McKeage K. Fentanyl sublingual: in breakthrough pain in opioid-tolerant adults with cancer. Drugs. 2010;70(17):2281–8.CrossRefPubMed
97.
Blick SK, Wagstaff AJ. Fentanyl buccal tablet: in breakthrough pain in opioid-tolerant patients with cancer. Drugs. 2006;66(18):2387–93. discussion 2394-5CrossRefPubMed
98.
Watts P, Smith A. PecSys: in situ gelling system for optimised nasal drug delivery. Expert Opin Drug Deliv. 2009;6(5):543–52.CrossRefPubMed
99.
Porta-Sales J, Garzón-Rodríguez C, Villavicencio-Chávez C, Llorens-Torromé S, González-Barboteo J. Efficacy and safety of methadone as a second-line opioid for cancer pain in an outpatient clinic: a prospective open-label study. Oncologist. 2016;21(8):981–7.CrossRefPubMed
100.
•• Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol. 2014;32:1739–47. Good discussion and review of issues and treatment of cancer survivors. CrossRefPubMedPubMedCentral