Chronic pain in cancer patients


  • Anastasiia Moisieienko Dobrobut Medical Network, Kyiv, Ukraine
  • Oleksandr Marchuk National Pirogov Memorial Medical University, Vinnytsia
  • Ivan Lisnyy National Cancer Institute, Kyiv, Ukraine
  • Dmytro Dmytriiev National Pirogov Memorial Medical University, Vinnytsia



pain, chronic pain, oncology, medical cannabis


Background. Pain is a complex clinical sign that is highly variable in both intensity and perception by patients. Often, a combination of symptoms and signs can indicate a pain syndrome specific to oncology. Virtually all patients with malignant diseases experience recurrent episodes of acute pain, which may accompany previous surgery, invasive procedures, or complications such as pathologic fractures or disease progression. Chronic pain is a huge economic burden on society, both in terms of health care and lost productivity.
Effective treatment of chronic pain results in significant improvements in general and psychological wellbeing and functioning of cancer patients and reduces the burden of chronic pain on health services.
The purpose is to clarify the problems of the prevalence of chronic pain in cancer patients, the complexity and variability of the pathophysiological mechanisms of the development of pain syndrome, to consider modern approaches to the management of patients with chronic pain.
Materials and methods. Modern foreign guidelines for the management of cancer patients with pain syndrome, written in English, data from metaanalyses, reviews and clinical studies were used.
Conclusions. Data from a 2016 crosssectional study to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain indicated that patients with chronic pain are at increased risk of developing depressive disorder of varying severity. About onethird of the study sample had major depression, and the overall prevalence of depression among individuals with chronic pain was higher than 50% [3].
Up to 75% of all cancer patients with chronic pain have nociceptive (somatic or visceral) or neuropathic syndromes, which are a direct consequence of the development and progression of the neoplasm. Other causes include anticancer drugs and disorders unrelated to the disease or its treatment.
Several systems are used to classify the pain syndrome, in particular — ECS-CP, IASP, ACTTION-APS.
Today, in the management of cancer patients with chronic pain, the WHO threestep analgesic ladder is used: the first two steps are paracetamol and NSAIDs, mild opioids (control of mild and moderate pain), the third is opioids. The selection of opioids, their dosage and titration features should take into account the individual characteristics of the patient in order to avoid overdose and addiction.
In addition to the abovementioned drugs, studies are being conducted to determine the effectiveness and feasibility of using medical cannabis as an alternative means, the use of which will improve the general condition of patients by relieving pain, and preventing the development of opioid addiction.
Interventional techniques (neurolytic blockades, neuraxial infusions, trigger point injections, spinal cord stimulation, intrathecal drug administration, and vertebral augmentation) are also used to control chronic pain. The application of physical and psychosocial methods in the comprehensive management of such patients is studied.


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Portenoy RK, Mehta Z, Ahmed E. Cancer pain management: General principles and risk management for patients receiving opioids. Available from:

van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain. 2007 Dec 5;132(3):312-320. Available from:

Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken LM. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain. 2016 Jul;157(7):1472-9. Available from:

Simon LS. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Journal of Pain & Palliative Care Pharmacotherapy. 2012 Jun 22;26(2):197–8. Available from:

Li Z, Aninditha T, Griene B, Francis J, Renato P, Serrie A, Umareddy I, Boisseau S, Hadjiat Y. Burden of cancer pain in developing countries: a narrative literature review. ClinicoEconomics and outcomes research. 2018;10:675-691. Available from:

Rau KM, Chen JS, Wu HB, Lin SF, Lai MK, Chow JM, et al. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Japanese Journal of Clinical Oncology. 2015 Nov 1;45(11):1042–9. Available from:

Wurjine TH, Goyteom MH Prevalence of cancer pain, anxiety and associated factors among patients admitted to oncology ward, Tikur Anbessa Specialized Hospital, Ethiopia, 2019. Open Journal of Pain Medicine. 2020 Apr 14;4(1):009–17. Available from:

Paice JA, Mulvey M, Bennett M, Dougherty PM, Farrar JT, Mantyh PW, et al. AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions. The Journal of Pain. 2017 Mar;18(3):233–46. Available from:

Cherny NI. et al. Chronic cancer pain syndromes. Oxford Textbook of Palliative Medicine. Oxford University Press; 2021. 345–363 p. Available from:

Portenoy RK, Mehta Z, Ahmed E. Cancer pain management: General principles and risk management for patients receiving opioids. Available from:

Chong WH, Molinolo AA, Chen CC, Collins MT. Tumor-induced osteomalacia. Endocrine-Related Cancer. 2011 Jun ;18(3):R53. Available from:

Nolan CP, Abrey LE. Leptomeningeal metastases from leukemias and lymphomas. Vol. 125, Cancer treatment and research. Springer, Boston, MA; 2005. 53–69 p. Available from:

Batool A, Kasi A. Leptomeningeal Carcinomatosis. StatPearls. StatPearls Publishing; 2022. Available from:

Kurt A Jaeckle. Plexopathies. Available from:

Gwathmey KG. Plexus and peripheral nerve metastasis. Vol. 149, Handbook of Clinical Neurology. Elsevier; 2018. 257–279 p. Available from:

Zis P, Paladini A, Piroli A, McHugh PC, Varrassi G, Hadjivassiliou M. Pain as a First Manifestation of Paraneoplastic Neuropathies: A Systematic Review and Meta-Analysis. Pain and Therapy. 2017 Dec 1;6(2):143–51. Available from:

Bhatnagar S, Ahmed A, Mishra S, Khurana D, Joshi S, Ahmad S. Prevalence of phantom limb pain, stump pain, and phantom limb sensation among the amputated cancer patients in India: A prospective, observational study. Indian Journal of Palliative Care. 2017;23(1):24. Available from:

Custodio C, Andrews CC. Radiation plexopathy July 25, 2012 Last updated: August 1, 2017 Available from:

Caraceni A, Shkodra M. Cancer Pain Assessment and Classification. Cancers (Basel). 2019 Apr 1;11(4). Available from:

Schofield M, Shetty A, Spencer M, Munglani R. Pain Managment: Part 1. British Journal of Family Medicine, 2 (3), May, 2014 Available from:

Cherny, N. et al. Oxford Textbook of Palliative Medicine 5 edn. Oxford University Press; 2015. Available from:

Nekolaichuk CL, Fainsinger RL, Aass N, Hjermstad MJ, Knudsen AK, Klepstad P, et al. The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity Across Diverse Palliative Care Settings in Eight Countries. Journal of Palliative Medicine. 2013 May;16(5):516–23. Available from:

Arthur J, Yennurajalingam S, Nguyen L, Tanco K, Chisholm G, Hui D, Bruera E. The routine use of the Edmonton Classification System for Cancer Pain in an outpatient supportive care center. Palliat Support Care. 2015 Oct;13(5):1185-92. Epub 2014 Oct 14. Available from:

Lawlor PG, Lawlor NA, Reis-Pina P. The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. Expert Review of Quality of Life in Cancer Care. 2018 Apr 26;3(2-3):47–64. Available from:

Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, et al. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2019;17(8):977–1007. Available from:

FDA Briefing Document Joint Meeting of the Drug Safety and Risk Management (DSaRM) Advisory Committee and Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC) June 11-12, 2019

Cancer Pain (PDQ®)–Health Professional Version - NCI/ Available from:

Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology. 2018 Oct;29:iv166–iv191. Available from:

Wiffen PJ, Derry S, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral paracetamol (acetaminophen) for cancer pain. Cochrane Database Syst Reviews. 2017 Jul 12;7(7):CD012637.

Derry S, Wiffen PJ, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral nonsteroidal anti‐inflammatory drugs (NSAIDs) for cancer pain in adults. Cochrane Database of Systematic Reviews 2017;7:CD012638. Available from:

Gaertner J, Stamer UM, Remi C, Voltz R, Bausewein C, Sabatowski R, Wirz S, Müller-Mundt G, Simon ST, Pralong A, Nauck F, Follmann M, Radbruch L, Meißner W. Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice. Palliat Med. 2017 Jan;31(1):26-34. Available from:

Portenoy RK, Ahmed E, Keilson YY. Cancer pain management: use of acetaminophen and non-steroidal anti-inflammatory drugs. Available from:

Huang R, Jiang L, Cao Y, Liu H, Ping M, Li W, et al. Comparative Efficacy of Therapeutics for Chronic Cancer Pain: A Bayesian Network Meta-Analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742–52. Available from:

Wiffen PJ, Derry S, Moore RA. Tramadol with or without paracetamol (acetaminophen) for cancer pain. Cochrane Database Syst Rev. 2017 May 16;5(5):CD012508. Available from:

Cherny NI, Baselga J, de Conno F, Radbruch L. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Annals of Oncology. 2010 Mar;21(3):615–26. Available from:

Portenoy RK, Mehta Z, Ahmed E. Cancer pain management: General principles and risk management for patients receiving opioids. Available from:

Portenoy RK, Mehta Z, Ahmed E. Cancer pain management with opioids: Optimizing analgesia. Available from:

Yoong J, Poon P. Principles of cancer pain management: An overview and focus on pharmacological and interventional strategies. Australian Journal of General Practice. 2018 Nov 1;47(11):758–62. Available from:

Aviram J, Lewitus GM, Vysotski Y, Amna MA, Ouryvaev A, Procaccia S, et al. The Effectiveness and Safety of Medical Cannabis for Treating Cancer Related Symptoms in Oncology Patients. Frontiers in Pain Research. 2022 May 20;3. Available from:

Portenoy RK, Copenhaver DJ, Cancer pain management: Interventional therapies. Available from:

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How to Cite

Moisieienko A, Marchuk O, Lisnyy I, Dmytriiev D. Chronic pain in cancer patients. PMJUA [Internet]. 2022 Sep. 5 [cited 2023 Mar. 27];7(2):4-17. Available from:



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