A new article offers clarity regarding the use of prescription opioids in pain management for people with a diagnosis or history of cancer and chronic pain.

The article, titled “Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease,” was published jointly in JNCCN (online April 7, 2020; doi: 10.6004/jnccn.2019.7379) and JCO Oncology Practice (online April 7, 2020; doi:10.1200/JOP.19.00675).

Contributors to the article include the National Comprehensive Cancer Network, American Society of Clinical Oncology, American Society of Hematology, Centers for Disease Control and Prevention (CDC), and Food and Drug Administration, among others.

Following a meeting in 2018, the CDC issued a letter of clarification that noted the agency’s guidelines were developed to provide recommendations for primary care clinicians who prescribe opioids for patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

The latest article provides a more granular explanation of different pain management guidelines and provides tools for determining how and why they differ. A noteworthy divergence point was intended recipients – including chronic pain sufferers, people in active cancer treatment, cancer survivors, and people with sickle cell disease.

However, the article also highlights points of agreement across guidelines, including:

Use of nonpharmacologic therapy and non-opioid pharmacologic therapy

Assessment of an individual’s likely benefit and risk prior to initiating opioid treatment

Development and implementation of strategies to maintain patient safety and minimize the risk of opioid misuse based on patient history and risk factors

Continuous monitoring and regular evaluations of effectiveness and necessity of opioid therapy

Patient education on goals of treatment and safer use of opioid analgesics

Optimization of adjuvant analgesics, psychosocial support, and interventional therapies in conjunction with opioid therapy

Gradual opioid dose reduction, when indicated, to prevent withdrawal symptoms

Authors of the guideline suggest that further utilization of clinical practice guidelines as a resource is needed to help inform policy, coverage determinations, and treatment decisions for safe, appropriate pain management. Furthermore, they call for additional coverage across payers for non-opioid pain management therapies and continued training for prescribers on how to appropriately transition patients with substance use issues off of opioids.—Zachary Bessette