Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
1
Guidelines for the Treatment of Cancer-related Neuropathic Pain
S Coyle,1 L McGlynn,
2 G Ting,
3, S Simpson,
4 E Sulaivany,
5 G Leng,
6 K Marley.
3 (Guideline
Development Lead)
1Willowbrook Hospice, Prescott;
2 Aintree University Hospital NHS Foundation Trust, Liverpool;
3 Woodlands Hospice,Liverpool;
4
Southport and Ormskirk Hospital NHS Trust, Southport;5 St Rocco’s Hospice, Warrington;
6 Hospice of the Good Shepherd,
Chester.
Summary Of Main Recommendations
Neuropathic pain has been defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” and is
common amongst patients with cancer.1,2
The evidence base for the treatment of cancer-related neuropathic pain is limited.
Pharmacological Management
The evidence supports the use of the following adjuvants in the treatment of cancer-related neuropathic pain: Gabapentin, Pregabalin and Amitriptyline. If there is no response to the initial adjuvant drug consider switching drug.
If there is partial response, consider adding a drug from a different class.
If no response or only a partial response then
consider alternative drugs or approaches and refer for anaesthetic intervention.
Non Pharmacological Options
Although the evidence is lacking for cancer-related neuropathic pain, non-pharmacological approaches should be considered alongside pharmacological therapies. This may include: transcutaneous electrical nerve stimulation (TENS); acupuncture; hydrotherapy and psychological interventions.
13-15
Interventional Pain Techniques
Interventional techniques may be indicated and should be discussed at an early stage with an Anaesthetic Pain Specialist.
11,12
Standards for Assessment and Management
Response to intervention for neuropathic pain should be monitored with pain scores/VAS before and after intervention.[Grade D]
Patients with severe pain or pain that is affecting ADLs should have at least weekly follow-up if an outpatient. The patient should be reassessed every 24 hours if an in-patient. [Grade D]
If neuropathic pain is escalating despite appropriate medical treatment, an Anaesthetic Pain Specialist should be contacted for advice within one week where available. [Grade D]
Clinical Assessment
A detailed history and clinical examination is essential. Investigations such as computerised tomography (CT) or magnetic resonance imaging (MRI) may be appropriate.
Screening tools are available to aid in the diagnosis of neuropathic pain such as the McGill Pain Questionnaire, S-LANSS and Neuropathic Pain Questionnaire.
Although screening tools are readily available they have not been specifically validated for the diagnosis of cancer-related neuropathic pain.
General Management Principles
The WHO analgesic ladder should be used.
Strong opioids should be titrated against response. There is no evidence to suggest the superiority of one strong opioid over another.
Adjuvants and non-opioids should be used as appropriate.
There is no evidence to recommend the routine first line use of NSAIDs in neuropathic cancer-related pain.
The endpoint of titration is pain relief or intolerable side effects. If dose-limiting side effects occur despite the use of adjuvants or other interventions, a switch of strong opioid should be considered.
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Section 1: Introduction
Neuropathic pain is common in patients with cancer. The Neuropathic Pain Special Interest Group (NEUPSIG) has redefined neuropathic pain as: “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” 1,2.
Currently, there is no gold standard test available to diagnose neuropathic pain. However, screening tools such as the McGill Pain Questionnaire, S-LANSS and the Neuropathic Pain Questionnaire are available within clinical practice to aid in the diagnosis of neuropathic pain. Although screening tools are readily available they have not been specifically validated for the diagnosis of cancer-related neuropathic pain.3
Neuropathic pain can be challenging to manage in clinical practice particularly as a result of the heterogeneity of the multiple aetiologies. Within the literature there is limited evidence specific to the management of cancer-related neuropathic pain. One of the primary aims of this guideline is to review the literature and current evidence base. The following guidance is an update of Merseyside and Cheshire Specialist Palliative Care Audit Group Guidelines for the Management of Cancer-related Neuropathic Pain developed in 2004 and updated in 2009.4
Section 2: Scope and Purpose This guideline is aimed primarily at practitioners in specialist palliative care including doctors, nurses, physiotherapists, occupational therapists and pharmacists. The guideline may also be of benefit to generalist providers of palliative care such as general practitioners, district nurses and those in secondary care.
The aims of the guideline are to:-
• Identify evidence based treatments for cancer-related neuropathic pain
• Provide guidance for the treatment of cancer-related neuropathic pain
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
3
Table 1: Summary of scope and purpose for this guideline.
Table 1: Scope of guideline
Population • Adults with cancer-related neuropathic pain
Populations not covered • Under 18 years of age, adult non cancer-related neuropathic pain
Healthcare setting
• People in their usual place of residence • Primary and community care • Secondary care • Hospice care
Topics
• Definition and diagnosis of cancer-related neuropathic pain
• Review of existing guidelines for the treatment of cancer-related neuropathic pain
• Role of opioids in the management of cancer-related neuropathic pain
• The role of adjuvants in cancer-related neuropathic pain
• The role of non-pharmacological approaches to managing cancer-related neuropathic pain
Topics not covered • Management of treatment related neuropathic pain • Management of non cancer-related neuropathic pain
Section 3: Methods The guideline is based on the AGREE II criteria which can be found in detail in the Cheshire and Merseyside Palliative and End of Life Care Network Audit Group Guideline Development Manual.5 Clinical Questions & Interventions
Clinical questions were derived from the previous guidance published in 2004 and reviewed in 2009.4 These were then refined by the Guideline Development Group which has authored this guideline. Specific clinical questions were formulated and used to guide the literature review. The PICO format (Patient, Intervention, Control, and Outcome) was adopted. The clinical questions used to review the evidence were as follows: What is the definition of cancer-related neuropathic pain? How is cancer related to neuropathic pain?
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
4
What are the existing guidelines for the treatment of cancer-related neuropathic
pain? Do opioids have a role in the management of cancer-related neuropathic pain? Are particular opioids better than others in the management of cancer-related
neuropathic pain? What is the evidence for the use of the following agents in cancer-related
neuropathic pain? - Anti-depressants - Anticonvulsants - Corticosteroids - Clonazepam - Capsaicin - Lidocaine - Tapentadol
What is the evidence for the following non-pharmacological approaches to managing cancer-related neuropathic pain? - TENS - acupuncture - hydrotherapy - psychological interventions
Outcomes
To improve the management of cancer-related neuropathic pain Literature Search
Systematic electronic database searches were undertaken to find potentially relevant articles. Ovid MEDLINE, EMBASE, CINAHL and Cochrane databases were searched in December 2013. A full explanation of the search strategy, results and appraisal of evidence can be found in Appendices 1-12. Grading of the level of evidence and recommendations follows the Cheshire and Merseyside Palliative and End of Life Care Network Audit Group Guideline Development Manual and uses SIGN criteria.5
Section 4: Guideline Recommendations
4.1. General Principles
Neuropathic pain may be relieved in the majority of patients by multimodal management. 6,7
A careful history and examination are essential.6 Investigations such as computerised tomography (CT) or magnetic resonance imaging (MRI) may be appropriate.7
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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It is important to have a logical and rational approach to prescribing. Pain diaries
may be useful to assess effect of intervention. Chemotherapy or radiotherapy may be indicated if the tumour is chemosensitive
or radiosensitive.8-12
Although the evidence is lacking for cancer-related neuropathic pain, non-pharmacological approaches should be considered alongside pharmacological therapies. This may include: transcutaneous electrical nerve stimulation (TENS); acupuncture; hydrotherapy and psychological interventions.13-15
Interventional techniques may be indicated and should be discussed at an early stage with an Anaesthetic Pain Specialist.16,17
4.2. Assessment and Monitoring
Undertake regular clinical reviews to assess and monitor the effectiveness of the treatment. Each review should include an assessment of:-
Pain control
Impact on lifestyle, daily activities (including sleep disturbance) and participation
Physical and psychological wellbeing
Adverse effects
Continued need for treatment 18
4.3. Pharmacological Management The WHO analgesic ladder should be followed.19
Strong opioids should be titrated against response. There is no evidence to
suggest the superiority of one strong opioid over another.20 Adjuvants and non-opioids should be used as appropriate. There is no evidence that the routine first line use of NSAIDs has a major role in
cancer-related neuropathic pain but they may be of some benefit.49
When using strong opioids, if dose limiting or intolerable side effects occur despite the use of adjuvants or other interventions, a switch of opioid could be considered.21
Figure 1 features a flow diagram which may be a useful guide for adjuvant prescribing in cancer-related neuropathic pain. [Level 1-]
If nerve compression is suspected, a trial of a short course of corticosteroids could be considered, although the evidence is weak. 22,23 For example use Dexamethasone 8mg daily for 5 days.24-26 Discontinue if no response. Reduce to lowest dose to maintain effect.27 If good response then the patient may benefit from radiotherapy. Monitor blood sugar levels. Consider gastric protection.28
4.4. Anaesthetic Intervention
Consider referring to anaesthetic pain specialists at any stage, including at initial presentation and at regular clinical reviews if:-
The patient has severe pain and/or escalating pain or
Pain significantly limits lifestyle, daily activities (including sleep disturbance) and participation.18 [Level 4]
For anaesthetic approaches see MCCN Guidelines on Interventional Pain
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Techniques.29
Anaesthetic intervention should not be considered as a last resort. [Level 4] 4.4. Complex Neuropathic Pain In patients with symptoms that are difficult to control or who have severe
allodynia / hyperalgesia, consider admission to a specialist unit. [Level 4] For treatment of resistant cancer-related neuropathic pain, Methadone and/or
Ketamine could be considered in a specialist palliative setting. (See MCCN Guidelines for Methadone and Ketamine use).30.31.
In patients who continue to have uncontrolled pain despite use of opioids, anticonvulsants and tricyclic antidepressants, medications which have been shown to be helpful in neuropathic pain not related to cancer could be tried as recommended in the current NICE guidelines for the management of neuropathic pain.18 See Table 1 for examples.
4.5. Parenteral Medication Patients who are unable to take oral analgesics and have ongoing pain should
be discussed with a senior Palliative Medicine physician. Strong opioids may be given via a continuous subcutaneous infusion. There are
no injectable options for the more commonly used adjuvants such as anticonvulsants and antidepressants.
Clonazepam may be given by continuous subcutaneous infusion but the evidence is weak.32 [Level 3]
4.6, Stopping Treatment In the event of a patient no longer requiring adjuvants for neuropathic pain, the
medication can be discontinued as recommended by the medication Summary of Product Characteristics (SPC):-
Duloxetine should be gradually tapered over a period of no less than two weeks, according to the patient's needs.
Gabapentin or Pregabalin should be discontinued gradually over a minimum of one week, independent of the indication.
There is no clear guidance for Amitriptyline but it is recommended that it is discontinued gradually.
For other medications please refer to the current British National Formulary.
The gradual reduction of medication may not be possible in patients who are in the last hours or days of life.
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Figure 1. Approaches to adjuvant analgesics in cancer-related neuropathic pain
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Table 1. Medication with an evidence base in the management of cancer-related
neuropathic pain
Drug Name Initial Dose Titration Side Effects Notes
Amitriptyline 33,34
[Level 1-]
10mg-25mg nocte
10mg at night in the
elderly.
Increase every 3
days as
tolerated
Occur in 33%
of patients.
Include
drowsiness
and dry mouth
Speed of onset 1-7 days.
May get improved sleep pattern
and mood.
Use with caution in : cardiac
disease; arrhythmias; epilepsy;
concurrent use of SSRIs; angle
closure glaucoma; history of
urinary retention
Gabapentin 33, 35-39
[Level 1-]
300mg nocte.
100mg nocte in the
elderly
Increase after 3
days to 300mg
bd. Increase to
300mg tds after a
further 3 days.
Maximum dose is
3600mg. Note:
May need to use
slower titration
regimen e.g. start
at 100mg od and
increase by
100mg every 2
days
Sedation,
dizziness. Reduce dose in renal failure /
impairment.
Use in caution in patients with
CCF.
Diabetic patients may need to
adjust hypoglycaemic treatment
as weight gain may occur.
Pregabalin 33,40-42
[Level 1-]
Day 1: 25mg od
Day 2: 25mg bd
Increase every 2
days by 25mg bd
150mg-600mg
daily in 2
divided doses.
Avoid tds
dosing.
Sedation,
dizziness Potential pharmacodynamic
interactions with all opioids and
sedatives.
Caution may be required in
patients with chronic heart
failure.
Diabetic patients may need to
adjust hypoglycaemic treatment
as weight gain may occur.
Morphine 37
[Level 1-]
Oramorph 2.5mg -
5mg PRN
Convert to a
sustained
release
morphine
preparation as
clinically
indicated
Beware of
opioid toxicity
Oxycodone 40
[Level 1-]
Oxynorm 1mg-2mg
PRN if opioid naive
Convert to a
sustained
release
oxycodone
preparation as
clinically
indicated
Beware of
opioid toxicity
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Table 2. Medications with an evidence base in non cancer-related neuropathic pain
Drug Name Initial Dose Titration Side Effects Notes
Duloxetine 47
[Level 1+]
60mg od Maximum 120mg per day in divided doses
Nausea, dry mouth, constipation, fatigue
Licensed for painful diabetic neuropathy
Capsaicin 0.075% cream
43
[Level 1-]
Apply topically 3 or 4 times daily
Skin burning and redness
May take up to 10 days to have an effect. Always wear gloves when applying
Carbamazepine 44
[Level 1-]
200mg daily 100mg daily in the elderly
Increase by 100mg-200mg every 3 days. Give in divided doses
Nausea, drowsiness, confusion and ataxia
Beware of drug interactions
Lidocaine patch 45
[Level 1-]
One strength. Apply for 12 hours daily over painful area and then remove.
Can use up to 3 patches at
any one time.
Skin reaction. Current evidence is for post herpetic neuropathic pain. May be useful for post thoracotomy pain.
Sodium Valproate
46
[Level 2-]
200mg nocte Increase by 200mg every 3 days. Maximum dose is 1000mg daily
Nausea, ataxia
Clonazepam 32
[Level 3]
500 micrograms nocte
Increase by 500mcg every 3 days. Maximum dose is 8mg
Sedation May be given subcutaneously via a syringe driver. May adsorb to PVC so use non PVC equipment for infusions.
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Sectin 5: Standards
1. Response to intervention for neuropathic pain should be monitored with pain scores/VAS, before and after intervention.4,7,48 [Grade D]
2. Patients with severe pain or pain that is affecting their ADLs should have at least weekly follow-up if an outpatient, and 24 hourly re-assessment if an in-patient.[Grade D]
3. If neuropathic pain is escalating despite appropriate medical treatment, an Anaesthetic Pain Specialist should be contacted for advice within one week where available. [Grade D]
Applications and Implications
The most pressing implication is for the education and training of palliative care professionals. Following publication, this guideline will be available to healthcare professionals online via the Merseyside and Cheshire Cancer Network website. Other means of increasing awareness regarding the management of cancer-related neuropathic pain include:- Discussion of this guideline during palliative medicine trainee induction
programmes and nursing staff inductions Audit meetings GP training / educational events Meetings with community specialist palliative care teams
Implications for practice include:- Healthcare professionals unaware of the guideline may not be prescribing in
accordance with the evidence base Access to anaesthetic pain specialists may vary throughout the region Capacity for weekly review of patients in clinics or the community Cost of medications may influence prescribing choices
Recommendations for research and service improvement include:- To re-audit this topic and the evidence based literature in three years after
publication Local case note reviews / audit of prescribing Ongoing education and raising awareness of guideline availability
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Acknowledgments and Declarations of Interest
Authors
Dr Seamus Coyle, Consultant in Palliative Medicine.
Laura McGlynn, Specialty Registrar in Palliative Medicine.
Dr Grace Ting, Specialty Registrar in Palliative Medicine.
Steve Simpson, Pharmacist
Dr Esraa Sulaivany, Associate Specialist in Palliative Medicine.
Dr Graham Leng, Consultant in Palliative Medicine.
Dr Kate Marley, Consultant in Palliative Medicine (Guideline Development Lead)
All authors have declared no conflict of interest in developing this guideline. Guideline production was funded through supporting professional activity time facilitated by the employing organisations of the authors. We gratefully acknowledge the work of:
Dr Helen Emms, Dr Clare Douglas, Professor Matt Makin and Dr Andrew Jones who developed the original guideline.
The Library Service at Bridgewater Community Healthcare NHS Trust for help with the literature searches.
Mr and Mrs F Rogers and Angela Fell our patient representatives.
Members of the Cheshire and Merseyside Palliative and End of Life Care Audit Group who submitted data for the regional audit which formed part of this project and also for contributing to guideline development through expert opinion.
Professor Mike Bennett, Professor of Palliative Medicine, University of Leeds and St Gemma’s Hospice who externally reviewed this guideline.
The authors contributed as follows: Literature Review: SC, LMcG, GT, SS, ES, GL KM. Audit Tools: SC, LMcG, GT, ES, GL KM. Updating Guidance and Grading SC, LMcG, GT, SS, ES, GL KM. Recommendations: SC, LMcG, GT, SS, ES, GL KM. Standards: SC, LMcG, GT, SS, ES, GL KM. Final writing of manuscript of guidelines: SC LMcG, KM, ES, GL.
Review Date
The guidelines will be reviewed three years after publication as outlined in the Cheshire and Merseyside Palliative and End of Life Care Network Audit Group Guideline Development Manual
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Appendix 1: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer Reviewers: S Coyle G Ting
Records identified Medline
(n = 206)
Records screened (n = 206)
Records excluded (n = 23)
73 – non-cancer pain 35 – non-neuropathic pain 40 – Treatment related 40 – Review articles 6 – Non-anticonvulsants
Full-text articles assessed for eligibility
(n = 13)
Full-text articles excluded, with reasons
(n = 3) 1 case series 1 descriptive study 1 retrospective study
Studies included in final literature review
(n = 10)
MEDLINE was searched using the following terms: ((cancer pain) AND anticonvulsant*) NOT non-cancer
Filters 10years, Humans, English
Role on Anticonvulsants in Cancer-related Neuropathic pain
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Date of Review: July 2021
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Role on Hydrotherapy in Cancer-related Neuropathic pain
Appendix 2: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer Reviewers: S Coyle G Ting
Records identified Medline
(n = 21)
Records screened (n = 21)
Records excluded (n = 21)
7 – non-cancer pain 9 – non-hydrotherapy 5 –non-Neuropathic pain
Full-text articles assessed for eligibility
(n = 0)
Full-text articles excluded, with reasons
(n = 0)
MEDLINE was searched using the following terms: ((cancer pain) AND hydrotherapy) NOT non-cancer
Filters 10years, Humans, English
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Appendix 3: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer Reviewers: S Coyle G Ting
Records identified Medline (n = 59)
Records screened (n = 62)
Records excluded (n = 56)
8 – non-cancer pain 7 – non-neuropathic pain 6 – Treatment related 30 – Non guideline 3 – Non-adult 2 – unrelated to criteria
Full-text articles assessed for eligibility
(n = 6)
Full-text articles excluded, with reasons
(n = 0)
Studies included in final literature review
(n = 6)
MEDLINE was searched using the following terms: ((cancer pain) AND anticonvulsant*) NOT non-cancer
Filters 10years, Humans, English
Existing Guidelines for Cancer- related Neuropathic Pain
Records identified through other
sources (3) (n = 3)
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Records after duplicates removed n = 16
Records screened n = 24
Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text; Biomedical Reference. Filters 10years, Humans, English
Collection: Comprehensive;MEDLINE
Search Terms: “Neuropathic pain” AND “Capsaicin OR cancer”
Records identified 24
articles n = 24
What is the evidence for the use of Capsaicin in cancer- related neuropathic pain?
Appendix 4: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records excluded (n=15)
15 – Irrelevant to cancer related neuropathic pain
Full-text articles assessed for eligibility
(n = 1)
Full-text articles excluded, with reasons
(n = 0)
Studies included in final literature review
(n = 0)
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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What is the definition of neuropathic pain and how do we diagnose it?
Records after duplicates removed n = 40
Full-text articles assessed for eligibility
(n = 32)
Full-text articles excluded, with reasons
n = 29 irrelevant
Studies included in final
literature review (n=3)
1 further article included but not found in literature search
(n=4)
Appendix 5: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records screened n = 55
Records excluded (n= 8 )
5 – Not available in English language
3 – Unable to access
Records identified 55
articles n = 55
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Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text;Biomedical Reference Collection: Comprehensive;MEDLINE Search Terms: “diagnosis” “assessment” “neuropathic” “pain” “cancer” “patients” Filters 10years, Humans, English
Search Terms: “diagnosis” “assessment” “neuropathic” “pain” “cancer” “patients”
Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
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Date of Review: July 2021
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Appendix 6: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records after duplicates removed (n=12)
Records screened (n=12)
Records excluded (n=0)
Full-text articles excluded, with reasons
(n = 12) 11 – Irrelevant to cancer related neuropathic pain
1 – Involved children
Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text;Biomedical Reference Collection: Comprehensive;MEDLINE Search Terms: “Lidocaine” AND “Neuropathic pain OR Cancer” Filters 10years, Humans, English
Collection: Comprehensive;MEDLINE
Search Terms: “Neuropathic pain” AND “Capsaicin OR cancer”
Records identified 14
articles (n = 14)
What is the evidence for the use of Lidocaine in the management of cancer- related neuropathic pain?
Full-text articles assessed for eligibility
(n=12)
Studies included in final literature review
(n = 0 )
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Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
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Appendix 7: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records after duplicates removed (n = 22)
Records screened (n = 22)
Full-text articles assessed for eligibility
(n =22)
Full-text articles excluded, with reasons
(n = 20) Irrelevant to cancer
related neuropathic pain
Studies included in final literature review
(n = 0 )
Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text;Biomedical Reference Collection: Comprehensive;MEDLINE. Filters 10years, Humans, English
Search Terms: “Scrambler” AND “Neuropathic pain”
Collection: Comprehensive;MEDLINE
Records identified articles (n = 24)
What is the evidence for the use of Scrambler therapy in the management of cancer- related neuropathic pain?
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Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
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Appendix 8: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records after duplicates removed n = 84
Records screened n = 84
Records excluded (n=82)
82 – Irrelevant to cancer related neuropathic pain
Full-text articles assessed for eligibility
(n =2)
Full-text articles excluded, with reasons
(n = 2) Irrelevant to cancer
related neuropathic pain
Studies included in final literature review
(n = 0 )
Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text;Biomedical Reference Collection: Comprehensive;MEDLINE . Filters 10years, Humans, English Search Terms: “Neuropathic pain” OR “Tapendatol” OR “cancer management”
Search Terms: “Scrambler” AND “Neuropathic pain”
Collection: Comprehensive;MEDLINE
Search Terms: “Neuropathic pain” AND “Capsaicin OR cancer”
Records identified articles n = 200
What is the evidence for the use of Tapendatol in the management of cancer-related neuropathic pain?
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
21
Appendix 9: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: L McGlynn, K Marley
Records after duplicates removed n = 162
Records screened n = 162
Full-text articles assessed for eligibility
(n =162 )
Full-text articles excluded, with reasons
(n = 162) Irrelevant to cancer
related neuropathic pain
Studies included in final literature review
(n = 0 )
Searched via EBSCOhost Research Databases Database - Health Business Elite;CINAHL with Full Text;GreenFILE;Library, Information Science & Technology Abstracts;MEDLINE;MEDLINE with Full Text;Biomedical Reference Collection: Comprehensive;MEDLINE Search Terms:“Transcutaneous electrical nerve stimulation” OR “neuropathic pain” OR “cancer related pain” Filters 10years, Humans, English
Search Terms: “Scrambler” AND “Neuropathic pain”
Collection: Comprehensive;MEDLINE
Search Terms: “Neuropathic pain” AND “Capsaicin OR cancer”
Records identified articles n = 224
What is the evidence for the use of TENS in the management of cancer-related neuropathic pain?
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
22
Databases searched: Medline PsycINFO and Embase Search Terms: Neuralgia, Neoplasm, Psychological interventions Searches limited to English, Humans and published between 2003 and 2014.
Evidence for the use of psychological intervention for the management of cancer- related neuropathic pain
Appendix 10: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: S Simpson, K Marley
Records identified Medline(n =2 )
Embase (n= 120) PsycINFO (n= 1)
Records screened (n =123)
Records excluded (n = 120)
• Different study
population
• Method of
intervention used.
Full-text articles assessed for eligibility
(n = 3)
Full-text articles excluded, with reasons
(n =3)
• 3 x review
article
Studies included in final literature review
(n =0)
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Production: July 2018
Date of Review: July 2021
23
Databases searched: Medline and Embase Search Terms: Neuralgia, antidepressive agents, cancer, neoplasms Searches limited to English, Humans and published between 2003 and 2014.
Evidence for the use of antidepressants for the management of cancer-related neuropathic pain
Appendix 11: Systematic Review Summary Form
Guideline Title: Neuropathic pain in cancer
Reviewers: S Simpson, K Marley
Records identified
Medline(n =8 ) Embase (n= 5)
Records screened (n =13)
Records excluded (n = 4)
• 3 duplicates
• 1 case history
Full-text articles assessed for eligibility
(n = 9)
Full-text articles excluded, with reasons
(n =6)
• 1 x prevalence
study
• 5 x review
Studies included in final literature review
(n =3)
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Publication: July 2018
Date of Review: July 2021
What is the evidence for the use of Opioids in the treatment of cancer-related neuropathic pain?
MEDLINE AND EMBASE, ADULTS, LAST 10years, English Terms used ((pain management) AND cancer patient) OR (cancer pain) OR cancer related pain)) AND (((neuropathy AND pain) OR( neuropathic pain) AND opioid OR opiate) OR (cancer)) AND ((neuropathy AND pain) OR( neuropathic pain)) AND (opioid OR opiate) limited to Cancer/Neoplasms in the MeSH and EMTREE thesauri
Appendix 12: Systematic Review Summary Form Guideline Title: Management of Cancer-related neuropathic pain Reviewers: Esraa Sulaivany and Graham Leng
Records screened (n =75 )
Studies included in final literature review
(n = 5)
Full-text articles assessed for eligibility
(n =9)
Full-text articles excluded, with reasons
(n = 4) Non cancer related neuropathic
pain , descriptive only
Records identified (n =75 )
Records excluded (n =66 )
Duplicate=6 Non-specific to neuropathic
pain=17 Cancer treatment related
neuropathic pain=11 Non opioids= 17
Non adult only= 2 Descriptive paper /pain
classification=13
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Publication: July 2018
Date of Review: July 2021
What is the evidence for the use of steroids in cancer related neuropathic pain?
Appendix 13: Systematic Review Summary Form Guideline Title: Management of Cancer-related neuropathic pain Reviewers: Esraa Sulaivany and Graham Leng
Records screened (n =25)
Records excluded (n =17 )
+ reasons why excluded Not neuropathic pain=8
Not steroids =2 Pain classification and
descriptive=3 Treatment related =4
Full-text articles assessed for eligibility
(n =8)
Studies included in final literature review
(n =1)
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Publication: July 2018
Date of Review: July 2021
What is the evidence for the use of clonazepam in cancer related neuropathic pain?
Appendix 14: Systematic Review Summary Form Guideline Title: Management of Cancer related neuropathic pain Reviewers: Esraa Sulaivany and Graham Leng
Records screened (n =8)
Records excluded (n =6 )
+ reasons why excluded Non cancer related and
treatment related
Full-text articles assessed for eligibility
(n =2 )
Studies included in final literature review
(n =1)
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Cheshire and Merseyside Palliative and End of Life Care Strategic Clinical Network Group Guidelines
Guidelines for the Management of Cancer-related Neuropathic Pain Date of Publication: July 2018
Date of Review: July 2021
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Date of Review: July 2021
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Guidelines for the Management of Cancer-related Neuropathic Pain Date of Publication: July 2018
Date of Review: July 2021
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