Fast Five Quiz: Oncology Pain Management

Winston W. Tan, MD


July 19, 2021

For neuropathic pain in adult cancer patients, antidepressants and anticonvulsants are considered first-line. Among antidepressants, tricyclics are the best-validated agents and most commonly prescribed. Anticholinergic adverse effects include dry mouth, sedation, and urinary hesitancy. While other antidepressants confer fewer adverse effects, less evidence supports their efficacy in managing neuropathic pain. Duloxetine is approved for management of painful neuropathy grade 2 or higher. A systematic literature search concluded that duloxetine remains a useful therapeutic option for pain in patients with chemotherapy-induced peripheral neuropathy, regardless of the type of chemotherapeutic agent used.

Glucocorticoids are effective for acute pain related to inflammation or nerve compression and for bone pain, but their extended use carries a risk for significant adverse effects. Patients experiencing non-emergency bone pain may benefit from bone-modifying agents. For local bone pain, consider local RT, nerve block, vertebral augmentation, or percutaneous ablation techniques. For diffuse bone pain, consider hormonal therapy or chemotherapy, corticosteroids, or systemic administration of radioisotopes. Bone pain may also be alleviated with an NSAID; a trial of bisphosphonates, hormone therapy, or chemotherapy; or physical therapy.

Learn more about palliative management of cancer pain.


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