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 Table of Contents  
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 59-65

Persistent chronic pain in cancer survivors: An update and future directions

Department of Anaesthesiology and Pain Medicine, University College of Medical Sciences, University of Delhi and GTB Hospital, New Delhi, India

Date of Submission14-Oct-2021
Date of Decision01-Dec-2022
Date of Acceptance09-Dec-2022
Date of Web Publication21-Dec-2022

Correspondence Address:
Suman Choudhary
No. 377 Kamla Nehru Nagar Chopasani Road, Jodhpur - 342 001, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/oji.oji_41_21

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Persistent chronic pain is the most common residual complaint in cancer survivors; its etiology being neoplastic process, postcancer treatment, or any other concurrent disorders. Growing concern about pain management in cancer survivors throws a mammoth challenge because more than 40% of cancer survivors now live longer than 10 years. Due to limited studies on persistent chronic pain in cancer survivors other than breast cancer, this enormous challenge remains in pain management in these cancer survivors. There are innumerable predictive factors for the development of persistent pain after cancer surgeries. It would be more prudent to concentrate on chronic pain mechanisms despite holding on to categorial risk factors and implanting them into patient outcomes. An effort should be made to a more holistic management of nociceptive and neuropathic pain in cancer survivor patients of Head and Neck, Prostate, and Lung carcinoma patients. In this article, we have tried to review the literature on managing chronic persistent pain in all cancer survivors, excluding carcinoma of the breast. In conclusion, we would like to emphasize that for an improved or excellent outcome of chronic persistent pain in cancer survivors, a holistic, multimodal approach encompassing pain relief techniques and pain relief strategies, relaxation exercises, cognitive behavioral therapy, and neuro-rehabilitative strategies would prove to be of immense help. A joint understanding between the pain management expert and the cancer survivors can result in beneficial outcomes.

Keywords: Cancer survivors, oncological modalities, persistent chronic pain

How to cite this article:
Choudhary S, Saxena AK, Bajaj M, Thakur A, Sonkar M. Persistent chronic pain in cancer survivors: An update and future directions. Oncol J India 2022;6:59-65

How to cite this URL:
Choudhary S, Saxena AK, Bajaj M, Thakur A, Sonkar M. Persistent chronic pain in cancer survivors: An update and future directions. Oncol J India [serial online] 2022 [cited 2023 Jun 4];6:59-65. Available from: https://www.ojionline.org/text.asp?2022/6/3/59/364564

  Introduction Top

Cancer remains the second-most mortality-causing disease in India, with about 0.3 million deaths per year.[1] All types of cancers have been reported in the Indian population, including the cancer of lung, skin, breast, rectum, stomach, prostate, bladder, blood, etc., out of which more than 40% of the total cancer burden was contributed by the seven leading cancer sites such as lung (10.6%), breast (10.5%), esophagus (5.8%), mouth (5.7%), stomach (5.2%), liver (4.6%), and cervix uteri (4.3%).[2]

Various treatment modalities for cancer patients starting from early screening, detection, and treatment, including surgery or chemo-radiotherapy, are readily available. Despite the latest up-gradation and improvement in the strategies for pain relief, chronic pain in cancer survivors remains a considerable challenge.

The prevalence of pain in cancer survivors has been as high as 40%.[3] Among all these cancer survivors, the greater prevalence of chronic pain is confined to cancer patients with metastasis. Studies suggest that up to 40% of those living beyond cancer are in pain and 5-10% have chronic severe pain that interferes with functioning, while one-third of 50% of cancer patients suffer from moderate-to-severe grading pain.[4],[5] Pain in cancer patients remains a burdensome problem in the current era of therapeutic advances in analgesia. Chronic pain in cancer of various types, such as breast, colon, lung, and liver, has been reported. In this review article, we have tried to provide insight into treatment and management in various cancer survivors, excluding breast cancer.

The etiology of cancer pain can be pain from an underlying malignant condition or its treatment. Common forms of pain are persistent postsurgical pain, chemotherapy-induced peripheral neuropathy (CIPN), radiation toxicity-associated pain, graft versus host disease-induced neuropathy, and aromatize inhibitor-induced arthralgia.[6]

  Chronic Persistent Pain in the Head and Neck Cancer Survivors Top

In patients with head-and-neck cancer, orofacial pain can appear as a symptom of regional or distant cancers by nociceptive/somatic, neuropathic, inflammatory, and visceral mechanisms.

Cancer in the orofacial region presents with spontaneous pain, which affects the daily routine function of eating, drinking, swallowing, and talking and is very painful. Regional orofacial pain and other sensory disturbances like trigeminal neuropathic pain, neuralgic symptoms such as sharp shooting pain, and neurovascular disorders such as headache occur in 80% of patients with head-and-neck cancers.

Orofacial pain of neuropathic origin can be a result of tumor resection, chemotherapy, radiotherapy, or combination therapy. Oral mucositis as a result of chemoradiotherapy is extremely painful even while eating, which leads to long-term nutritional deficiency. Postradiation musculoskeletal complaints such as trismus, contracture, fibrosis, and scarring of muscles of mastication and temporomandibular joints ligaments affect the mouth opening and eating process.[7],[8]

  Chronic Persistent Pain in Lung Cancer Survivors Top

Patients with lung cancer experience more symptoms of distress than patients with other types of cancers. The three main causes of pain in patients with advanced lung cancer are skeletal metastatic disease (34%), pancoast tumor (31%), and chest wall disease (21%). It is estimated that approximately 75% of cancer patients live with chronic pain; this pain is secondary to nociceptive or neuropathic syndromes, which represent the direct effects of cancer. Chest pain is a frequent and disabling symptom, worsening with disease progression, and is present in approximately 20% of patients presenting with lung cancer. Pain is frequently on the ipsilateral chest at the tumor site. Periosteal inflammation and elevation are the most common mechanism of pain from bone metastases. Lung cancer metastases to bone are predominately lytic. Cancer-induced bone pain has been shown to have unique characteristics and is a complex pain state. Sensory and sympathetic neurons are present within the bone marrow, mineralized bone, and periosteum, and all these compartments are affected by tumor cells. Metastatic bone pain is, therefore, complex to manage due to nociceptive, neuropathic, and visceral stimulation overlapping.[9]

Types of causes of pain in lung cancer survivors are depicted in [Table 1].
Table 1: Common causes of pain in lung cancer survivors

Click here to view

  Chronic Persistent Pain in Colorectal Cancer Survivors Top

With advanced treatment, colorectal cancer (CRC) is transformed from a deadly disease to a curable illness. Over 90% of invasive CRCs are diagnosed in patients over the age of 50, with 67% being diagnosed in patients over the age of 65. CRC is the most common cancer diagnosed in patients over age 75.[10] Long-term CRC survivors have begun to address the late- and long-term effects of newer treatment regimens. Oxaliplatin-induced peripheral neuropathy has become common and occasionally dose-limiting toxicity in the CRC survivor population, usually manifesting as sensory impairment of the peripheral nerves in a stocking-glove distribution. Symptoms of numbness, pain, paraesthesia, dysesthesias, and changes in proprioception may affect fine motor skills such as writing, holding objects, buttoning shirts, picking up coins, and walking. Rarely, urinary retention and Lhermitte's sign (electric-shock sensation shooting down the spine with neck flexion) can occur. Both preoperative and postoperative radiation for rectal cancer increases the risk of long-term bowel dysfunction. Survivors who underwent an anterior resection surgery reported a median of three bowel movements per day, frequency, urgency, evacuation difficulties, and inability to differentiate stool and gas. These symptoms were most problematic during the 1st year after resection and were associated with fear, poor body image, and low self-confidence. Postradiotherapy for rectal cancer patient risk for pelvic insufficiency and fracture due to radiation bone damage may be increased.[11]

  Chronic Persistent Pain in Prostate Cancer Survivors Top

Prostate cancer is one of the most common causes of cancer in men and is the second most common cause of cancer death after lung cancer. Advanced prostate cancer can be debilitating. Bone pain, fatigue, and weight loss are common, and increasing dependence and a feeling of losing control can contribute to anxiety and depression. Other symptoms include urinary outflow obstruction, weakness secondary to spinal cord compression, lymphedema, and anemia. Bone disease with pain is present in 90% of patients with metastatic prostate cancer. Bone lesions in the spine can lead to nerve root compression and neuropathic pain. This pain typically radiates along a nerve root and is sharp, burning, or tingling in nature. Bone pain in prostate cancer is usually dull, constant and gradually intensifying in nature. With the increasing size of the prostate tumor, the second type of breakthrough pain begins to occur as it “breaks through” the analgesic regimen the patient is receiving to control the ongoing pain. It is frequently divided into two types: A “pontaneous pain” that occurs without any obvious precipitating event and a “movement-evoked pain” precipitated by the movement of the tumor-bearing bone. Breakthrough pains are very severe and unpredictable, disabling the patient's functional status and quality of life, resulting in a significant increase in health-care utilization.[12],[13]

  Chronic Persistent Pain in Carcinoma Ovary Survivors Top

As the population ages, there is an increase in the number of older women with ovarian cancer. Nearly 50% of the patients with ovarian cancer are diagnosed above the age of 65 years, and over 70% of them die from the same. Compared to younger females, the older population with ovarian cancer receives less surgery and chemotherapy, develops worse toxicity, and has poorer outcomes. Surgery is paramount because the amount of residual tumor is a major prognostic factor for survival. Older patients are at risk of increased surgical morbidity and mortality. For confirmed ovarian cancer patients, definite surgery includes total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, retroperitoneal lymph node sampling, diaphragm inspection, peritoneal biopsies, and washings.[14] Hysterectomy is a common gynecological surgery, and chronic pain reported following hysterectomy is seen in 5%–32%. Nerve injury-induced neuropathic pain has been considered to be the main pathogenic mechanism for the development of chronic persistent postsurgical pain.[15]

Pain syndromes associated with cancer treatment are listed in [Table 2].[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29]
Table 2: Chronic pain syndromes related to cancer treatment[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29]

Click here to view

  Chemotherapy-Induced Peripheral Neuropathy Top

CIPN represents a major cause of pain affecting peripheral sensory neuropathy in 68% of cancer during 1st month and in 60%, of 3 months after chemotherapy. Pain is bilateral, presenting as tingling, burning, or numbness in character, which is generally dose dependent and not completely reversible. Risk factors for CIPN include preexisting neuropathies, old age, being treated with paclitaxel, etc., Mechanisms of CIPN are tested on animal models for treatment in advance prospects. For example, oxaliplatin, paclitaxel, and vincristine cause an increase in abnormally high spontaneous discharges in A-beta and C fiber nociceptors, causing peripheral neuropathies. Mitochondrial function disruption, sodium-potassium pump alterations, cytokine-mediated inflammation, and deficiency in nerve growth factors and brain-derived neurotrophic factor have also been implicated in the mechanism of CIPN.

Drugs commonly associated with CIPN are listed in [Table 3].[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53]
Table 3: Drugs responsible for chemotherapy-induced peripheral neuropathy[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53]

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  Approaches to Treatment Top

All cancer treatment modalities have the potential to cause pain. A personalized, patient-based approach to pain management remains the keystone for cancer pain. The WHO first launched the analgesic step ladder approach for providing cancer pain relief worldwide, yet it has limitations in the context of longer survival and increasing incidence of disease. The current ladder method failed to provide satisfactory relief in 10%–20% of patients of advanced stage, especially neuropathic pain and pain associated with bone involvement. Suggestions of adding a fourth, “interventional,” step be added to the 3-step WHO analgesic ladder is incorporated. Chronic pain management guidelines by the National Comprehensive Cancer Network 2013 aim at a multidisciplinary approach to achieve comfort, improve functionality, limit adverse events, and ensure safety.[54],[55],[56]

  NonPharmacological Interventions for Chronic Pain Top

Several non-pharmacological interventions have been used for chronic pain management such as[57],[58],[59],[60],[61],[62],[63],[64],[65]

  1. Physical medicine and rehabilitation, such as physical therapy, occupational therapy, and recreational therapy
  2. Integrative therapies such as massage, acupuncture, and music
  3. Interventional therapies such as nerve blocks, neuraxial infusion, and vertebroplasty
  4. Psychological approaches such as cognitive behavioral therapy (CBT), distraction, and relaxation
  5. Neurostimulation therapies include TENS, spinal cord stimulation, PNS, and transcranial stimulation.

  Pharmacological Interventions Top

Many systemic nonopioids, antidepressants, anticonvulsants, and various nutraceuticals and botanicals are used for treatment in cancer patients. Opioid remains the mainstay of cancer treatment and are prescribed round the clock. Commonly used preparations include morphine, oxycodone, transdermal patches of fentanyl, and methadone. For breakthrough pain, immediate-release preparations should be considered. The risk-benefit ratio of long-term opioid treatment should be assessed, and its judicious use to optimize the approach to achieve analgesia or improve functional status with minimum side effects.[66],[67],[68],[69],[70],[71],[72],[73]

In a very recent study by Vitzthum et al.[74] involving a cohort of more than 100,000 military veterans of frequently encountered cancers, the authors concluded that in prostate and lung cancer patients who have already been treated with radiotherapy, there was an enhanced requirement of opioids in comparison to those patients who have surgical intervention. Strong opioid was required for head-and-neck cancer in comparison to gastrointestinal cancers; lung, head and neck, breast, and prostate cancers are associated with more somatic pain, whereas colorectal, gastric, liver, pancreatic, and uterine cancers were associated more with visceral pain. In patients with terminal-stage cancer, opioids may require dose reduction, switching, or opioid antagonist for respiratory depression risk.[75]

  Chronic Pain in Elderly Cancer Survivors Top

In this modern era, “geriatric oncology” has almost been designated as an important onco specialty that looks after a special category of the geriatric population who already may be having cognitive impairment, dementia, Alzheimer's, behavioral changes, and barriers in communication. Paracetamol remains a good option as an adjuvant for pain control in old chronic cancer patients. Other medications used for treatment are listed in [Table 4]. Considering the systemic impairment, including renal and hepatic functions, treatment protocol should be followed accordingly and prescribed cautiously. Other analgesics include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants, and anticonvulsants such as gabapentin and pregabalin for neuropathic pain conditions or for chronic widespread pain, in cancer survivors.[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88]
Table 4: Drugs for cancer pain treatment in older patients

Click here to view

In the opinion of Antman,[84] Patrono,[80] and Strawson,[85] NSAIDs at reduced doses; are supposed to be cardioprotective. On the other hand, with their continuous, long-term therapy, they do exaggerate the risk of cerebrovascular accidents (CVAs), and myocardial infarctions (MIs). However, there is hardly any literature regards exaggerated risk in cancer survivors, who have been using NSAIDS on a prolonged basis.

The list of drugs for cancer pain treatment in older patients, along with geriatric considerations and side effects, are depicted in [Table 4].[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86]

  Conclusion Top

We would like to emphasize that for an improved or excellent outcome of chronic persistent pain in cancer survivors, a holistic, multimodal approach encompassing pain relief techniques and pain relief strategies, relaxation exercises, CBT and neuro rehabilitative strategies would prove to be of immense help. At the same time, education is essentially required to minimize theft, channeling and diversion of opioids when used in the management of chronic persistent pain in cancer survivors and to encourage patients to have free justified and rational access to opioids, ensuring that these opioids are prevented from entering the community. It is high time that we bring an innovative educational program for chronic pain in cancer survivors. There can be a paradigm shift through the implementation and integration of pain neuroscience education into a multimodal, holistic approach for a bio-psycho-social approach in the management of chronic persistent pain.

It is possible that transferring that knowledge to cancer survivors, shall allow them to understand and effectively cope with their pain. This may require explaining to the patient that persistent chronic pain in cancer survivors is the submission of various processes within the nervous system, which may or may not include nocioception, or poorly explain current tissue damage or illness. We must eliminate the therapeutic barrier and optimize therapeutic compliance.


Our sincere thanks to cancer survivors.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, Dhingra N, et al. Prospective study of one million deaths in India: Rationale, design, and validation results. PLoS Med 2006;3:e18.  Back to cited text no. 1
Kulothungan V, Sathishkumar K, Leburu S, Ramamoorthy T, Stephen S, Basavarajappa D, et al. Burden of cancers in India – Estimates of cancer crude incidence, YLLs, YLDs and DALYs for 2021 and 2025 based on national cancer registry program. BMC Cancer 2022;22:527.  Back to cited text no. 2
Davidsen M, Kjøller M, Helweg-Larsen K. The Danish national cohort study (DANCOS). Scand J Public Health 2011;39:131-5.  Back to cited text no. 3
van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage 2016;51:1070-90.e9.  Back to cited text no. 4
Heathcote LC, Eccleston C. Pain and cancer survival: A cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence. Pain 2017;158:1187-91.  Back to cited text no. 5
Werner MU, Kongsgaard UE. I. Defining persistent post-surgical pain: Is an update required? Br J Anaesth 2014;113:1-4.  Back to cited text no. 6
Romero-Reyes M, Salvemini D. Cancer and orofacial pain. Med Oral Patol Oral Cir Bucal 2016;21:e665-71.  Back to cited text no. 7
Kallurkar A, Kulkarni S, Delfino K, Ferraro D, Rao K. Characteristics of chronic pain among head and neck cancer patients treated with radiation therapy: A retrospective study. Pain Res Manag 2019;2019:9675654.  Back to cited text no. 8
Simmons CP, Macleod N, Laird BJ. Clinical management of pain in advanced lung cancer. Clin Med Insights Oncol 2012;6:331-46.  Back to cited text no. 9
Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors. Prz Gastroenterol 2019;14:89-103.  Back to cited text no. 10
Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw 2009;7:883-93.  Back to cited text no. 11
Thompson JC, Wood J, Feuer D. Prostate cancer: Palliative care and pain relief. Br Med Bull 2007;83:341-54.  Back to cited text no. 12
Jimenez-Andrade JM, Bloom AP, Stake JI, Mantyh WG, Taylor RN, Freeman KT, et al. Pathological sprouting of adult nociceptors in chronic prostate cancer-induced bone pain. J Neurosci 2010;30:14649-56.  Back to cited text no. 13
Tew WP, Muss HB, Kimmick GG, Von Gruenigen VE, Lichtman SM. Breast and ovarian cancer in the older woman. J Clin Oncol 2014;32:2553-61.  Back to cited text no. 14
Saxena AK, Chilkoti GT, Chopra AK, Banerjee BD, Sharma T. Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes. Korean J Pain 2016;29:239-48.  Back to cited text no. 15
Paice JA. Chronic treatment-related pain in cancer survivors. Pain 2011;152:S84-9.  Back to cited text no. 16
Schreiber KL, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, et al. Persistent pain in postmastectomy patients: Comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain 2013;154:660-8.  Back to cited text no. 17
Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert Rev Neurother 2009;9:723-44.  Back to cited text no. 18
Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008;101:77-86.  Back to cited text no. 19
Glendenning JL, Barbachano Y, Norman AR, Dearnaley DP, Horwich A, Huddart RA. Long-term neurologic and peripheral vascular toxicity after chemotherapy treatment of testicular cancer. Cancer 2010;116:2322-31.  Back to cited text no. 20
Cavaletti G, Alberti P, Frigeni B, Piatti M, Susani E. Chemotherapy-induced neuropathy. Curr Treat Options Neurol 2011;13:180-90.  Back to cited text no. 21
Vincenzi B, Frezza AM, Schiavon G, Spoto C, Silvestris N, Addeo R, et al. Identification of clinical predictive factors of oxaliplatin-induced chronic peripheral neuropathy in colorectal cancer patients treated with adjuvant Folfox IV. Support Care Cancer 2013;21:1313-9.  Back to cited text no. 22
Loprinzi CL, Reeves BN, Dakhil SR, Sloan JA, Wolf SL, Burger KN, et al. Natural history of paclitaxel-associated acute pain syndrome: Prospective cohort study NCCTG N08C1. J Clin Oncol 2011;29:1472-8.  Back to cited text no. 23
Xiao WH, Bennett GJ. Chemotherapy-evoked neuropathic pain: Abnormal spontaneous discharge in A-fiber and C-fiber primary afferent neurons and its suppression by acetyl-L-carnitine. Pain 2008;135:262-70.  Back to cited text no. 24
Park SB, Lin CS, Krishnan AV, Friedlander ML, Lewis CR, Kiernan MC. Early, progressive, and sustained dysfunction of sensory axons underlies paclitaxel-induced neuropathy. Muscle Nerve 2011;43:367-74.  Back to cited text no. 25
Park SB, Lin CS, Krishnan AV, Goldstein D, Friedlander ML, Kiernan MC. Oxaliplatin-induced neurotoxicity: Changes in axonal excitability precede development of neuropathy. Brain 2009;132:2712-23.  Back to cited text no. 26
Park SB, Goldstein D, Lin CS, Krishnan AV, Friedlander ML, Kiernan MC. Acute abnormalities of sensory nerve function associated with oxaliplatin-induced neurotoxicity. J Clin Oncol 2009;27:1243-9.  Back to cited text no. 27
Zheng H, Xiao WH, Bennett GJ. Mitotoxicity and bortezomib-induced chronic painful peripheral neuropathy. Exp Neurol 2012;238:225-34.  Back to cited text no. 28
Meregalli C, Canta A, Carozzi VA, Chiorazzi A, Oggioni N, Gilardini A, et al. Bortezomib-induced painful neuropathy in rats: A behavioral, neurophysiological and pathological study in rats. Eur J Pain 2010;14:343-50.  Back to cited text no. 29
Wang XM, Lehky TJ, Brell JM, Dorsey SG. Discovering cytokines as targets for chemotherapy-induced painful peripheral neuropathy. Cytokine 2012;59:3-9.  Back to cited text no. 30
Park SB, Goldstein D, Krishnan AV, Lin CS, Friedlander ML, Cassidy J, et al. Chemotherapy-induced peripheral neurotoxicity: A critical analysis. CA Cancer J Clin 2013;63:419-37.  Back to cited text no. 31
Herskovits S, Schaumburg HH. Neuropathy caused by drugs. In: Dyck PJ, Thomas PK, editors. Peripheral Neuropathy. Philadephia: Elsevier Saunders; 2005. p. 2553-83.  Back to cited text no. 32
Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain 2014;8:139-53.  Back to cited text no. 33
Bennett GJ, Doyle T, Salvemini D. Mitotoxicity in distal symmetrical sensory peripheral neuropathies. Nat Rev Neurol 2014;10:326-36.  Back to cited text no. 34
LaPointe NE, Morfini G, Brady ST, Feinstein SC, Wilson L, Jordan MA. Effects of eribulin, vincristine, paclitaxel and ixabepilone on fast axonal transport and kinesin-1 driven microtubule gliding: Implications for chemotherapy-induced peripheral neuropathy. Neurotoxicology 2013;37:231-9.  Back to cited text no. 35
Peters CM, Jimenez-Andrade JM, Kuskowski MA, Ghilardi JR, Mantyh PW. An evolving cellular pathology occurs in dorsal root ganglia, peripheral nerve and spinal cord following intravenous administration of paclitaxel in the rat. Brain Res 2007;1168:46-59.  Back to cited text no. 36
Warwick RA, Hanani M. The contribution of satellite glial cells to chemotherapy-induced neuropathic pain. Eur J Pain 2013;17:571-80.  Back to cited text no. 37
Yoon SY, Robinson CR, Zhang H, Dougherty PM. Spinal astrocyte gap junctions contribute to oxaliplatin-induced mechanical hypersensitivity. J Pain 2013;14:205-14.  Back to cited text no. 38
Cavaletti G, Cornblath DR, Merkies IS, Postma TJ, Rossi E, Frigeni B, et al. The chemotherapy-induced peripheral neuropathy outcome measures standardization study: From consensus to the first validity and reliability findings. Ann Oncol 2013;24:454-62.  Back to cited text no. 39
Alaedini A, Xiang Z, Kim H, Sung YJ, Latov N. Up-regulation of apoptosis and regeneration genes in the dorsal root ganglia during cisplatin treatment. Exp Neurol 2008;210:368-74.  Back to cited text no. 40
Han Y, Smith MT. Pathobiology of cancer chemotherapy-induced peripheral neuropathy (CIPN). Front Pharmacol 2013;4:156.  Back to cited text no. 41
Jin HW, Flatters SJ, Xiao WH, Mulhern HL, Bennett GJ. Prevention of paclitaxel-evoked painful peripheral neuropathy by acetyl-L-carnitine: Effects on axonal mitochondria, sensory nerve fiber terminal arbors, and cutaneous Langerhans cells. Exp Neurol 2008;210:229-37.  Back to cited text no. 42
Siau C, Xiao W, Bennett GJ. Paclitaxel and vincristine-evoked painful peripheral neuropathies: Loss of epidermal innervation and activation of Langerhans cells. Exp Neurol 2006;201:507-14.  Back to cited text no. 43
Seretny M, Currie GL, Sena ES, Ramnarine S, Grant R, MacLeod MR, et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Pain 2014;155:2461-70.  Back to cited text no. 44
Verstappen CC, Heimans JJ, Hoekman K, Postma TJ. Neurotoxic complications of chemotherapy in patients with cancer: Clinical signs and optimal management. Drugs 2003;63:1549-63.  Back to cited text no. 45
Durand JP, Deplanque G, Montheil V, Gornet JM, Scotte F, Mir O, et al. Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: Results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Ann Oncol 2012;23:200-5.  Back to cited text no. 46
Rao RD, Michalak JC, Sloan JA, Loprinzi CL, Soori GS, Nikcevich DA, et al. Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy: A phase 3 randomized, double-blind, placebo-controlled, crossover trial (N00C3). Cancer 2007;110:2110-8.  Back to cited text no. 47
Saif MW, Syrigos K, Kaley K, Isufi I. Role of pregabalin in treatment of oxaliplatin-induced sensory neuropathy. Anticancer Res 2010;30:2927-33.  Back to cited text no. 48
Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: A randomized clinical trial. JAMA 2013;309:1359-67.  Back to cited text no. 49
Alvarez P, Ferrari LF, Levine JD. Muscle pain in models of chemotherapy-induced and alcohol-induced peripheral neuropathy. Ann Neurol 2011;70:101-9.  Back to cited text no. 50
Argyriou AA, Cavaletti G, Briani C, Velasco R, Bruna J, Campagnolo M, et al. Clinical pattern and associations of oxaliplatin acute neurotoxicity: A prospective study in 170 patients with colorectal cancer. Cancer 2013;119:438-44.  Back to cited text no. 51
Ruiz-Medina J, Baulies A, Bura SA, Valverde O. Paclitaxel-induced neuropathic pain is age dependent and devolves on glial response. Eur J Pain 2013;17:75-85.  Back to cited text no. 52
Chaudhry V, Cornblath DR, Polydefkis M, Ferguson A, Borrello I. Characteristics of bortezomib and thalidomide-induced peripheral neuropathy. J Peripher Nerv Syst 2008;13:275-82.  Back to cited text no. 53
Argyriou AA, Iconomou G, Kalofonos HP. Bortezomib-induced peripheral neuropathy in multiple myeloma: A comprehensive review of the literature. Blood 2008;112:1593-9.  Back to cited text no. 54
Office of Cancer Survivorship, National Cancer Institute. About Cancer Survivorship Research: Survivorship Definitions, Cancer Survivorship Research. Washington, DC: Office of Cancer Survivorship, National Cancer Institute; 2012.  Back to cited text no. 55
Ahmedzai SH. Cancer pain for the 21st century: Stepping off the ladder, stepping up to new challenges. Br J Pain 2014;8:131-2.  Back to cited text no. 56
American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: An updated report by the American society of anesthesiologists task force on chronic pain management and the American society of regional anesthesia and pain medicine. Anesthesiology 2010;112:810-33.  Back to cited text no. 57
Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 2012;2012:CD007566.  Back to cited text no. 58
Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, et al. Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ 2012;344:e70.  Back to cited text no. 59
Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev 2015;2015:CD007753.  Back to cited text no. 60
Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev 2011;2011:CD007519.  Back to cited text no. 61
Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: A multicentre, randomised controlled trial. Lancet Oncol 2011;12:225-35.  Back to cited text no. 62
Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain 2011;152:533-42.  Back to cited text no. 63
Cramer H, Lauche R, Paul A, Langhorst J, Kümmel S, Dobos GJ. Hypnosis in breast cancer care: A systematic review of randomized controlled trials. Integr Cancer Ther 2015;14:5-15.  Back to cited text no. 64
Johannsen M, Farver I, Beck N, Zachariae R. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: A systematic review and meta-analysis. Breast Cancer Res Treat 2013;138:675-90.  Back to cited text no. 65
Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 2012;30:539-47.  Back to cited text no. 66
Hurlow A, Bennett MI, Robb KA, Johnson MI, Simpson KH, Oxberry SG. Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. Cochrane Database Syst Rev 2012;2012:CD006276.  Back to cited text no. 67
Nabal M, Librada S, Redondo MJ, Pigni A, Brunelli C, Caraceni A. The role of paracetamol and nonsteroidal anti-inflammatory drugs in addition to WHO Step III opioids in the control of pain in advanced cancer. A systematic review of the literature. Palliat Med 2012;26:305-12.  Back to cited text no. 68
Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011;3:CD007938.  Back to cited text no. 69
Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010;150:573-81.  Back to cited text no. 70
Paulsen Ø, Aass N, Kaasa S, Dale O. Do corticosteroids provide analgesic effects in cancer patients? A systematic literature review. J Pain Symptom Manage 2013;46:96-105.  Back to cited text no. 71
von Moos R, Body JJ, Egerdie B, Stopeck A, Brown JE, Damyanov D, et al. Pain and health-related quality of life in patients with advanced solid tumours and bone metastases: Integrated results from three randomized, double-blind studies of denosumab and zoledronic acid. Support Care Cancer 2013;21:3497-507.  Back to cited text no. 72
Wong SS, Cheung CW. Optimization of opioid utility in cancer pain populations. Ann Palliat Med 2020;9:558-70.  Back to cited text no. 73
Vitzthum LK, Riviere P, Sheridan P, Nalawade V, Deka R, Furnish T, et al. Predicting persistent opioid use, abuse, and toxicity among cancer survivors. J Natl Cancer Inst 2020;112:720-7.  Back to cited text no. 74
Zylla D, Steele G, Shapiro A, Richter S, Gupta P. Impact of opioid use on health care utilization and survival in patients with newly diagnosed stage IV malignancies. Support Care Cancer 2018;26:2259-66.  Back to cited text no. 75
Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American pain society recommendations for improving the quality of acute and cancer pain management: American pain society quality of care task force. Arch Intern Med 2005;165:1574-80.  Back to cited text no. 76
Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, 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;162:276-86.  Back to cited text no. 77
Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 2010;251:759-65.  Back to cited text no. 78
Urban D, Cherny N, Catane R. The management of cancer pain in the elderly. Crit Rev Oncol Hematol 2010;73:176-83.  Back to cited text no. 79
Kress HG. Clinical update on the pharmacology, efficacy and safety of transdermal buprenorphine. Eur J Pain 2009;13:219-30.  Back to cited text no. 80
Naing C, Yeoh PN, Aung K. A meta-analysis of efficacy and tolerability of buprenorphine for the relief of cancer pain. Springerplus 2014;3:87.  Back to cited text no. 81
Tracy B, Sean Morrison R. Pain management in older adults. Clin Ther 2013;35:1659-68.  Back to cited text no. 82
Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med 2009;150:387-95.  Back to cited text no. 83
American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009;57:1331-46.  Back to cited text no. 84
Antman EM. Evaluating the cardiovascular safety of nonsteroidal anti-inflammatory drugs. Circulation 2017;135:2062-72.  Back to cited text no. 85
Patrono C. Cardiovascular effects of nonsteroidal anti-inflammatory drugs. Curr Cardiol Rep 2016;18:25.  Back to cited text no. 86
Strawson J. Nonsteroidal anti-inflammatory drugs and cancer pain. Curr Opin Support Palliat Care 2018;12:102-7.  Back to cited text no. 87
Aiyer R, Barkin RL, Bhatia A. Treatment of neuropathic pain with venlafaxine: A systematic review. Pain Med 2017;18:1999-2012.  Back to cited text no. 88


  [Table 1], [Table 2], [Table 3], [Table 4]


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