Skip to main content

Advertisement

SpringerLink
Log in

Substance Abuse in Cancer Pain

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

In the oncology community, opioids recently have become the cornerstone of cancer pain management. This has led to a rapid increase in opioid prescribing in an effort to address the growing public health problem of chronic pain. A new paradigm in noncancer pain management has emerged, that of risk assessment and stratification in opioid therapy. Techniques foreign to cancer pain management have now become commonplace in the noncancer pain setting, such as the use of monitoring compliance via urine drug screens. Amidst these strides in opioid use for pain management, cancer has been changing. The survival rate has increased, and a group of these patients with chronic pain were treated with opioid therapy. With opioid exposure being longer and against the backdrop of prescription drug abuse, the question is how much of the adaptation of the risk management paradigm in chronic pain management is to be imported to cancer pain management?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Passik SD, Kirsh KL: Forget the recipes: let’s talk data. Pain Medicine 2008, 9:261–265. This article describes the ongoing debate in opioid prescribing in patients with cancer and noncancer chronic pain. Specifically, it highlights the need for risk assessment and individually tailored treatment regimens depending on a patient’s level of risk for opioid abuse. It also discusses important considerations for managing breakthrough pain.

    Article  Google Scholar 

  2. Passik SD, Olden M, Kirsh KL, Portenoy RK: Substance abuse issues in palliative care. In Principles and Practice of Palliative Care and Supportive Oncology, edn 3. Edited by Berger AM, Portenoy RK, Weissman DE. Philadelphia: Lippincott Williams & Wilkins; 2007:593–603.

    Google Scholar 

  3. Burton RW, Lyons JS, Devens M, Larson DB: Psychiatric consultations for psychoactive substance disorders in the general hospital. Gen Hosp Psychiatry 1991, 13:83–87.

    Article  CAS  PubMed  Google Scholar 

  4. Colliver JD, Kopstein AN: Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Drug Abuse Warning Network. Public Health Rep 1991, 106:59–68.

    CAS  PubMed  Google Scholar 

  5. Derogatis LR, Morrow GR, Fetting J, et al.: The prevalence of psychiatric disorders among cancer patients. JAMA 1983, 249:751–757.

    Article  CAS  PubMed  Google Scholar 

  6. Gfroerer J, Brodsky M: The incidence of illicit drug use in the United States, 1962–1989. Br J Addict 1992, 87:1345–1351.

    Article  CAS  PubMed  Google Scholar 

  7. Regier DA, Myers JK, Kramer M, et al.: The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 1984, 41:934–941.

    CAS  PubMed  Google Scholar 

  8. American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, edn 3. Washington DC: American Psychiatric Association; 1983.

    Google Scholar 

  9. Kirsh KL, Whitcomb LA, Donaghy L, Passik SD: Abuse and addiction issues in medically ill patients with pain: Attempts at clarification of terms and empirical study. Clin J Pain 2002, 18(4 Suppl):S52–S60.

    Article  PubMed  Google Scholar 

  10. Volkow ND: Scientific research on prescription drug abuse, before the Subcommittee on Crime and Drugs, Committee on the Judiciary and the Caucus on International Narcotics Control United States Senate. Available at http://www.drugabuse.gov/Testimony/3-12-08Testimony.html. Accessed April 2010.

  11. United States Department of Health and Human Services: The National Survey on Drug Use and Health (NSDUH) Report: Patterns and Trends in Nonmedical Prescription Pain Reliever Use: 2002 to 2005. Available at http://www.oas.samhsa.gov/2k7/pain/pain.htm. Accessed May 2008.

  12. United States Department of Health and Human Services: Results from the 2005 National Survey on Drug Use and Health: National Findings. Available at http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm. Accessed May 2008.

  13. Cleeland CS, Ryan KM: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994, 23:129–138.

    CAS  PubMed  Google Scholar 

  14. Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16:606–613.

    Article  CAS  PubMed  Google Scholar 

  15. Stratford PW, Binkley J, Solomon P, et al.: Defining the minimum level of detectable change for the Roland-Morris questionnaire. Phys Ther 1996, 76:359–365.

    CAS  PubMed  Google Scholar 

  16. •• Passik SD, Kirsh KL: The interface between pain and drug abuse and the evolution of strategies to optimize pain management while minimizing drug abuse. Exp Clin Psychopharmacol 2008, 16:400–404. This important review highlights the need to screen patients with chronic pain for addiction and abuse risk throughout the duration of pain management, including even before initiation of opioid therapy.

    Article  PubMed  Google Scholar 

  17. Akbik H, Butler SF, Budman SH, et al.: Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage 2006, 32:287–293.

    Article  PubMed  Google Scholar 

  18. Butler SF, Budman SH, Fernandez K, Jamison RN: Validation of a screener and opioid assessment measure for patients with chronic pain. Pain 2004, 112:65–75.

    Article  CAS  PubMed  Google Scholar 

  19. Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med 2005, 6:432–442.

    Article  PubMed  Google Scholar 

  20. Passik SD, Weinreb HJ: Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids. Adv Ther 2000, 17:70–83.

    Article  CAS  PubMed  Google Scholar 

  21. Passik SD, Kirsh KL, McDonald MV, et al.: A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. J Pain Symptom Manage 2000, 19:274–286.

    Article  CAS  PubMed  Google Scholar 

  22. Portenoy RK, Lussier D, Kirsh KL, Passik SD: Pain and addiction. In Clinical Textbook of Addictive Disorders, edn 3. Edited by Frances RJ, Miller SI, Mack AH. New York: Guilford Press; 2005:367–395.

    Google Scholar 

  23. Passik SD, Kirsh KL: Managing pain in patients with aberrant drug-taking behaviors. J Support Oncol 2005, 3:83–86.

    PubMed  Google Scholar 

  24. Passik SD, Kirsh KL, Whitcomb L, et al.: A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther 2004, 26:552–561.

    Article  CAS  PubMed  Google Scholar 

  25. Ballantyne JC, Mao J: Opioid therapy for chronic pain. N Engl J Med 2003, 349:1943–1953.

    Article  CAS  PubMed  Google Scholar 

  26. Haythornthwaite JA, Menefee LA, Quatrano-Piacentini AL, Pappagallo M: Outcome of chronic opioid therapy for non-cancer pain. J Pain Symptom Manage 1998, 15:185–194.

    Article  CAS  PubMed  Google Scholar 

  27. Raja SN, Haythornthwaite JA, Pappagallo M, et al.: Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002, 59:1015–1021.

    CAS  PubMed  Google Scholar 

  28. Weissman DE, Haddox JD: Opioid pseudoaddiction—an iatrogenic syndrome. Pain 1989, 36:363–366.

    Article  CAS  PubMed  Google Scholar 

  29. Pappagallo M: The concept of pseudotolerance to opioids. J Pharm Care Pain Symptom Control 1998, 6:95–98.

    Article  Google Scholar 

  30. Smith HS: Variations in opioid responsiveness. Pain Physician 2008, 11:237–248.

    PubMed  Google Scholar 

  31. Smith HS, Deer TR, Staats PS, et al.: Intrathecal drug delivery. Pain Physician 2008, 11(2 Suppl):S89–S104.

    PubMed  Google Scholar 

  32. Bennett D, Burton AW, Fishman S, et al.: Consensus panel recommendations for the assessment and management of breakthrough pain: Part 1 Assessment. P and T 2005, 30:296–301.

    Google Scholar 

  33. Zeppetella G: Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief. J Pain Symptom Manage 2008, 35:563–567.

    Article  PubMed  Google Scholar 

  34. Caraceni A, Martini C, Zecca E, et al.: Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 2004, 18:177–183.

    Article  PubMed  Google Scholar 

  35. Fortner BV, Demarco G, Irving G, et al.: Description and predictors of direct and indirect costs of pain reported by cancer patients. J Pain Symptom Manage 2003, 25:9–18.

    Article  PubMed  Google Scholar 

  36. Portenoy RK, Payne D, Jacobsen P: Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999, 81:129–134.

    Article  CAS  PubMed  Google Scholar 

  37. Fine PG, Busch MA: Characterization of breakthrough pain by hospice patients and their caregivers. J Pain Symptom Manage 1998, 16:179–183.

    Article  CAS  PubMed  Google Scholar 

  38. Hwang SS, Chang VT, Kasimis B: Cancer breakthrough pain characteristics and responses to treatment at a VA medical center. Pain 2003, 101(1–2):55–64.

    Article  PubMed  Google Scholar 

  39. Mercadante S, Radbruch L, Caraceni A, et al.: Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer 2002, 94:832–839.

    Article  PubMed  Google Scholar 

  40. Portenoy RK, Hagen NA: Breakthrough pain: definition, prevalence and characteristics. Pain 1990, 41:273–281.

    Article  CAS  PubMed  Google Scholar 

  41. Svendsen KB, Andersen S, Arnason S, et al.: Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms. Eur J Pain 2005, 9:195–206.

    Article  PubMed  Google Scholar 

  42. Portenoy RK, Lesage P: Management of cancer pain. Lancet 1999, 353:1695–1700.

    Article  CAS  PubMed  Google Scholar 

  43. Fortner BV, Okon TA, Portenoy RK: A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain 2002, 3:38–44.

    Article  PubMed  Google Scholar 

  44. Bruera E, Schoeller T, Wenk R, et al.: A prospective multicenter assessment of the Edmonton staging system for cancer pain. J Pain Symptom Manage 1995, 10:348–355.

    Article  CAS  PubMed  Google Scholar 

  45. Mercadante S, Maddaloni S, Roccella S, Salvaggio L: Predictive factors in advanced cancer pain treated only by analgesics. Pain 1992, 50:151–155.

    Article  CAS  PubMed  Google Scholar 

  46. Bennett D, Burton AW, Fishman S, et al.: Consensus panel recommendations for the assessment and management of breakthrough pain. Part 2. Management. P T 2005, 30:354–361.

    Google Scholar 

  47. Eichman JD, Robinson JR: Mechanistic studies on effervescent-induced permeability enhancement. Pharm Res 1998, 15:925–930.

    Article  CAS  PubMed  Google Scholar 

  48. Durfee S, Messina J, Khankari RK: Fentanyl effervescent buccal tablets. Am J Drug Deliv 2006, 4:1–5.

    Article  CAS  Google Scholar 

  49. Coluzzi PH, Schwartzberg L, Conroy JD, et al.: Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 2001, 91:123–130.

    Article  CAS  PubMed  Google Scholar 

  50. FENTORA [package insert]. Available at http://www.fentora.com/hcp300_default.aspx. Accessed March 1, 2010.

  51. Banning A, Sjogren P, Henriksen H: Treatment outcome in a multidisciplinary cancer pain clinic. Pain 1991, 47:129–134.

    Article  CAS  PubMed  Google Scholar 

  52. McQuay HJ, Jadad AR: Incident pain. Cancer Surv 1994, 21:17–24.

    CAS  PubMed  Google Scholar 

Download references

Disclosure

Dr. Steven Passik has served as a consultant for Ameritox, Cephalon, Meda AB, Prostrakan, Purdue Pharma, and King Pharmaceuticals and as a speaker for Ameritox, Cephalon, Meda AB, King Pharmaceuticals, and Calloway Labs. No other potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA

    Tatiana D. Starr & Steven D. Passik

  2. Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, 2nd Floor, New York, NY, 10065, USA

    Lauren J. Rogak

Authors
  1. Tatiana D. Starr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren J. Rogak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven D. Passik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven D. Passik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Starr, T.D., Rogak, L.J. & Passik, S.D. Substance Abuse in Cancer Pain. Curr Pain Headache Rep 14, 268–275 (2010). https://doi.org/10.1007/s11916-010-0118-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-010-0118-6

Keywords

Search

Navigation