This session will discuss the problem of chronic pain as a survivorship issue.
Pain is prevalent among outpatient oncology patients, affecting 2/3-3/4 of patients. While it may be due to cancer or a side-effect of treatment, people with cancer can also have concomitant non-malignant pain, approximately 2/3 in one survey.(1) In the past, opioids were the mainstay of pain relief in cancer patients. As patients are living longer after diagnosis, continuing opioid therapy long-term in cancer patients is causing similar concerns as in the chronic non-cancer pain population (diminishing efficacy but ongoing risks of side effects, tolerance, addiction, and overdose).
Consequently, there growing interest in the non-pharmacologic pain management in oncology. One approach is the prescription of integrative therapies such as acupuncture, massage therapy, yoga, and music therapy. Another approach is the use of psychological therapies (e.g., CBT-based pain self-management programs) that address unhelpful thoughts and beliefs about pain which drive pain-related distress and disability. Psychological therapies are effective for chronic pain but not widely used in the oncology setting - historically, cancer pain was considered to be fundamentally different to chronic non-malignant pain.(2) Nowadays, it is increasingly recognized that cancer survivors with pain-related distress and disability often have poor pain coping (low pain self-efficacy and high pain catastrophizing), just like patients with non-cancer pain.(3,4) This is an important survivorship issue, as poor pain coping is a modifable cause of unhealthy behaviours like inactivity, weight gain, insomnia, fatigue, depression, stress, substance use. The evidence base for studies of non-pharmacologic interventions for pain in cancer survivors will be reviewed.(5)