Cancer Doctors Prescribing Fewer Opioids Since Opioid Crisis

PainRelief.com Interview with:
Joshua Kra, MD
Assistant Professor of Medicine, Rutgers NJMS
Division of Hematology/Oncology
Rutgers Cancer Institute of New Jersey at University Hospital

PainRelief.com: What is the background for this study?

Response: We aimed to characterize pain management practices by medical oncologists to assess whether CDC guidelines from 2017 for nononcologic settings changed prescribing patterns for oncologists.

PainRelief.com: What are the main findings?

Response: There was a significant decrease in opioid prescriptions from medical oncologists starting in 2017, which coincided with the recognition of the opioid crisis as a national public health emergency and the publication of CDC guidelines for opiate prescribing in non-cancer settings. This would suggest these factors contributed to how oncologists changed their management of opioid prescriptions for cancer patients.

Acupuncture and Massage May Be Part of Pain Management Plan in Patients with Advanced Cancer

PainRelief.com Interview with:
Jun J. Mao, MD, MSCE
Chief, Integrative Medicine Service
Laurance S. Rockefeller Chair in Integrative Medicine
Memorial Sloan Kettering Cancer Center

PainRelief.com: What is the background for this study?

Response: Most of the pain intervention trials focused on cancer survivors who completed treatment or patients in hospice care, little is know how these treatments work in patients living with advanced cancer. With the improvement in cancer treatment, many people are now living with advanced cancer but suffer from pain from their cancer or treatment.

Since acupuncture and massage have been found effective to manage pain in other populations, we designed this study to compare the effectiveness of these two interventions for musculoskeletal pain among patients living with advanced cancer. We hoped these results will aid patients and their doctors to make informed decision in pain treatment.

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Acupuncture During Gynecology Cancer Surgery Reduced Post-Op Pain

PainRelief.com Interview with:
Prof. Eran Ben-Arye MD
Co-founder and director of the Unit of Complementary and Traditional Medicine
Department of Family Medicine, Haifa
Director of the Integrative Oncology Program within the Haifa and Western Galilee Oncology Service, Lin Medical Center, Clalit Health Services
Chairperson of the Israel Society for Complementary Medicine of the Israel Medical Association

Prof. Ben-Arye

PainRelief.com: What is the background for this study?

Response: The study was part of an initiative whose stated goal was providing continuity of integrative oncology care to patients with gynecology cancer. Over the past 14 years we have been offering patients undergoing chemotherapy with integrative oncology treatments without charge, helping improve their quality of life and increasing their adherence to the conventional oncology treatment protocol.

The research presented in the current paper examined the introduction of the integrative treatment from as early as the time of cancer diagnosis and throughout the pre-surgical, surgical and post-surgical inpatient setting.
The integrative process was a collaborative effort, taking place together with a team of surgeons, anesthesiologists and nurses throughout all stages of peri-operative care of the gynecology oncology patient. 

Marijuana May Be Substituting for Opioids for Cancer-Related Pain Relief

PainRelief.com Interview with:
Yuhua Bao, PhD
Department of Population Health Sciences, Department of Psychiatry
Weill Cornell Medicine, New York, New York

Dr. Yuhua Bao

PainRelief.com: What is the background for this study?

Response: We know that opioid use is declining among cancer patients. We also know that marijuana use is increasing among cancer patients; this increase is related to the recent wave of medical marijuana legalization (adopted by 37 states and D.C. as of Feb 2022).

We do not know if medical marijuana legalization has led to changes in opioid use for cancer patients and what were the implications for cancer pain outcomes.

Study Highlights Challenges of Opioid Use Disorder in Patients with Cancer Pain

PainRelief.com Interview with:
Katie Fitzgerald Jones MSN, APN
PhD candidate Connell School of Nursing
Boston College
Jonas Mental Health Scholar 2021-2023
American Academy of Nursing Jonas Policy Scholar 
Ruth L. Kirschstein National Service Award (F31NR019929-01)

PainRelief.com:  What is the background for this study? 

Response: I am a Palliative and Addiction Nurse Practitioner at VA Boston and a Ph.D. candidate at Boston College Connell School of Nursing. In my clinical practice, I regularly care for people with cancer who have a co-occurring substance use disorder. 

How to best care for people with substance use disorders, such as opioid use disorder is especially complex in people with cancer because opioid management is a standard of cancer-pain management and cancer prognoses can influence opioid decisions and vary. It is important when prescribing opioids that you attend to safety while also addressing pain. People with untreated opioid use disorder or concerning opioid behaviors (such as taking more opioids than prescribed or using opioids with unprescribed medications that increase the risk for opioid-related harm such as benzodiazepines) have an increased risk for opioid related-harms. It is also an area that lacks consensus and is absent from cancer-specific pain guidelines.

This study was conducted with leaders in palliative care including senior author, Jessica Merlin to tackle the question of what is consensus among palliative care and addiction clinicians to caring for people with opioid misuse or use disorder and cancer-related pain and how this is influenced by prognosis?