Better Options for Chronic Cancer Pain

This trial explores new methods to help cancer survivors manage chronic pain without relying on opioids. It tests various treatment plans, including medication adjustments and multimodal pain care (a combination of different therapies), to determine which best reduces opioid use. The focus is on veterans who have overcome cancer but still experience significant pain and are on long-term opioid therapy. Veterans who have been cancer-free for at least six months and continue to suffer from frequent, severe pain while using opioids would be suitable candidates for this study. As a Phase 4 trial, the treatment is already FDA-approved and proven effective, offering veterans the opportunity to benefit from established therapies.

The trial does not specify if you need to stop taking your current medications, but you must be on long-term opioid therapy and have an agreement with your current opioid prescriber to resume prescribing after the study. You cannot participate if you are on high doses of opioids, use buprenorphine, or have certain other conditions.

Research has shown that the treatments under study for improving pain relief in cancer survivors have been safe in previous studies.

For those considering multiple methods for pain care, earlier research has found that these approaches help people use pain medications safely and improve pain relief without major side effects. This often results in better pain management with fewer problems.

Adjusting and fine-tuning different pain medications, known as medication optimization, has also been shown to be generally safe. Studies have found it effective in managing pain, with serious side effects being rare.

Switching from other opioids to buprenorphine, known as buprenorphine rotation, has been linked to lower pain levels. Existing data indicates it usually does not cause withdrawal symptoms or other major health issues.

Gradually reducing opioid use, known as opioid tapering, can sometimes cause withdrawal symptoms or increased pain. However, some patients report better function and quality of life after tapering. Research suggests that careful monitoring can help manage these risks.

Researchers are excited about these multimodal pain care treatments for chronic cancer pain because they offer a more personalized approach than standard options like opioids or non-opioid medications alone. These treatments combine medication optimization with personalized care plans crafted by a team physician and the patient, potentially enhancing effectiveness and reducing reliance on opioids. Some plans include opioid tapering or buprenorphine rotation, which could help manage pain with fewer side effects and lower addiction risk. By addressing pain from multiple angles and incorporating patient collaboration, these treatments aim to provide more comprehensive relief and improve overall quality of life.

This trial will explore various strategies for managing chronic cancer pain. Studies have shown that a combination of different treatments, known as multimodal pain care, can effectively reduce pain and improve the quality of life for people with chronic pain. Research indicates that this approach can significantly lessen pain and decrease the need for pain-relieving medications. Participants in this trial may receive multimodal pain care for either 6 or 9 months.

Evidence suggests that non-opioid treatments can work as well as weaker opioids for managing cancer pain, with many patients experiencing good or excellent pain relief. Some participants will undergo medication optimization for either 6 or 9 months, with the possibility of transitioning to buprenorphine rotation or opioid tapering after 6 months.

Switching from other opioids to buprenorphine, a process called buprenorphine rotation, has reduced pain without causing withdrawal symptoms in many cases. This is one of the strategies being tested in this trial.