Narrative Review of Clinical Pharmacist Contributions to Cancer Pain Control:integration of Who Guidelines and Pain Assessment Tool
Main Article Content
Abstract
Pain is a prevalent and distressing symptom in cancer patients, affecting up to 90% depending on cancer type and stage. It arises from multiple sources including the tumor, treatments, and comorbidities, significantly impairing quality of life, psychological
well-being, and treatment adherence. Despite advances in pharmacologic therapies and evidence based guidelines like the WHO’s three-step analgesic ladder, cancer pain remains underassessed and inadequately managed globally. Barriers include clinician knowledge gaps, opioid related concerns, limited medication access, and fragmented care, especially in resource-limited settings. Emerging clinical pharmacist-led analgesic stewardship programs offer innovative solutions to these challenges by optimizing pain assessment, individualized treatment, opioid management, and patient education. Pharmacists bring specialized pharmacotherapeutic expertise, playing a vital role in tailoring analgesic regimens, monitoring efficacy and adverse effects, and fostering interdisciplinary collaboration. Studies demonstrate that pharmacist involvement improves pain control, medication adherence, and patient satisfaction while reducing medication-related complications and healthcare costs. Opioid stewardship is critical due to risks of misuse and regulatory scrutiny. Pharmacists contribute by applying guideline recommendations,
individualizing therapy based on pharmacokinetics and pharmacogenomics, and implementing risk mitigation strategies consistent with CDC and international guidelines. Accurate pain assessment using validated tools—Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Rating Scale (VRS)—is foundational to effective management. Pharmacists enhance guideline
implementation by training healthcare teams, ensuring consistent assessment, and integrating pain evaluation into clinical workflows.Overall, clinical pharmacist-led interventions align with global best practices and are integral to comprehensive, patient centered oncology pain management. Their involvement bridges the gap between guidelines and clinical practice, promoting safer, more effective analgesic use and improving outcomes in cancer patients experiencing pain
References
van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EA, Tjan-Heijnen VCG, Janssen DJA.
Update on prevalence of pain in patients with cancer: systematic review and meta-analysis.
J Pain Symptom Manage. 2016;51(6):1070–1090.e9.
Mystakidou K, Tsilika E, Parpa E, Katsouda E, Vlahos L.
Psychological distress of patients with advanced cancer: influence and impact on quality of life.
Support Care Cancer. 2005;13(9):743–749.
Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, et al.
Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer.
J Clin Oncol. 2014;32(36):4149–4154.
Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al.
Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes.
Ann Oncol. 2009;20(8):1420–1433.
World Health Organization.
Cancer Pain Relief: With a Guide to Opioid Availability. 2nd ed. Geneva: WHO; 1996.
Cleary J, Simha N, Panieri A.
Integration of palliative care into oncology: evidence, global models, and challenges in low- and middle-income countries.
Cancer. 2020;126(20):4641–4652.
Wahab SMA, Alshehri AM, Alqahtani MA, et al.
Role of clinical pharmacists in pain management in cancer patients: a review.
Saudi Pharm J. 2021;29(2):97–106.
Kwon JH.
Overcoming barriers in cancer pain management.
J Clin Oncol. 2014;32(16):1727–1733.
World Health Organization.
WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents.
Geneva: WHO; 2018.
Fallon M, Giusti R, Aielli F, et al.
Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.
Ann Oncol. 2018;29(Suppl 4):iv166–iv191.
Caraceni A, Hanks G, Kaasa S, et al.
Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC.
Lancet Oncol. 2012;13(2):e58–e68.
Li M, Zhang Y, Wang X, et al.
Impact of a clinical pharmacist-led guidance team on cancer pain management: a prospective, multicenter, randomized controlled study.
Support Care Cancer. 2014;22(6):1583–1589.
Centers for Disease Control and Prevention (CDC).
CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022.
MMWR Recomm Rep. 2022;71(3):1–95.
Price DD, McGrath PA, Rafii A, Buckingham B.
The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.
Pain. 1983;17(1):45–56.
Paice JA, Ferrell B.
The management of cancer pain.
CA Cancer J Clin. 2011;61(3):157–182.
Caraceni A, Cherny N, Fainsinger R, et al.
Pain measurement tools and methods in clinical research in palliative care: recommendations of an expert working group of the European Association for Palliative Care.
J Pain Symptom Manage. 2002;23(3):239–255.
Chou R, Turner JA, Devine EB, et al.
The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.
Ann Intern Med. 2015;162(4):276–286.
Pereira L, Figueiredo I, Almeida A.
Pharmacist interventions to improve adherence to antidepressant medication: a systematic review.
Int J Clin Pharm. 2014;36(1):36–47.
Smith HS.
Opioid metabolism.
Mayo Clin Proc. 2009;84(7):613–624.
Zhang Y, Liu Y, Li X, et al.
Therapy by physician–pharmacist combination and economic returns for cancer pain management in China: a cost-effectiveness analysis.
Support Care Cancer. 2023;31(1):45–54.
Dowell D, Haegerich TM, Chou R.
CDC guideline for prescribing opioids for chronic pain—United States, 2016.
JAMA. 2016;315(15):1624–1645.
Koshy S, Carver A, McGuire TM.
Integrating oncology pharmacists into multidisciplinary care teams for improved patient outcomes.
Pharmacy (Basel). 2021;9(1):23.
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.