NO DIFFERENCE between cancer and non-cancer pain

[Full text] Terminology of chronic pain: the need to “level the playing field | JPR | John F Peppin, Michael E Schatman

This article points out the absurdity of the dichotomy between cancer-related and non-cancer pain. As I’ve always believed, there is NO DIFFERENCE when it comes to pain mechanisms or pain treatments.

As it continues to find its way in the ever-changing world of medicine, terminology [of pain medicine] becomes an important consideration.

“Chronic cancer pain” and “chronic noncancer pain” are replete in the literature; however, the distinction here is actually obscure. 

A patient with pain from a cancer etiology has no different physiology than a patient with pain of noncancer etiologies.  

Interestingly, these claims are primarily philosophical, rather than medical or physiologic.

As mentioned, pain mechanisms do not discriminate between cancer and noncancer pathophysiology.

Patients with cancer or those without cancer have essentially identical pain-generating physiologies, and thus the same mechanisms for the development of their pain

Further, cancer patients are living longer and their original pain generators become chronic pain in and of themselves, little different from patients without cancer.

Frequently, the claim is that those without cancer should not have to undergo the side effects of opioids, and they should not have to take on the potential burden of iatrogenic addiction.

Furthermore, they note that there are few data to support opioid use in these patients. 

Interestingly, the data on the use of opioids in cancer patients suffer from the same criticism, lack of long-term data, and lack of data demonstrating increased functionality

However, there is frequently the caveat that those with cancer should receive opioids, which represents a rather strange dichotomy.

This line of reasoning can be interpreted as follows:

1. We do not care if the patient with cancer suffers from side effects, fatal or otherwise from opioids, and/or develops a substance-use disorder.
2. But we do care if a patient with chronic “noncancer” pain develops these problems.
3. We do not care if patients with noncancer pain suffer; they are not “worth” the effort of adding opioids to their regimens.

Obviously, given other considerations associated with initiating chronic opioid therapy and the need for continued reevaluation, opioids may not be the best option. However, simply the label of “chronic noncancer pain” should not immediately place that patient in a category that eliminates certain potential therapies, eg, opioids.

Categorization into “cancer” and “noncancer” does not help us better understand mechanisms underlying pain or guide us to appropriate treatment strategies. Further, these categories are philosophical and neither scientific nor of clinical relevance

The goal here is to continue to be patient-focused, relieve their suffering (instead of contributing to it), and help improve their lives.

I congratulate these two doctors for publicizing this grossly invalid artificial dualism between cancer-related pain and non-cancer pain.