Supportive treatment for cancer – Part 3

SCIENTIFIC REPORT 10 -- 1 INTRODUCTION 10 -- 1.1 CONTEXT 10 -- 1.2 GENERAL SCOPE 11 -- 1.3 TARGET USERS OF THE GUIDELINE 11 -- 1.4 STATEMENT OF INTENT 12 -- 1.5 FUNDING AND DECLARATION OF INTEREST 12 -- 1.6 IMPLEMENTATION AND UPDATING OF THE GUIDELINE 12 -- 1.6.1 Implementation 12 -- 1.6.2 Monitoring the quality of care 12 -- 1.6.3 Guideline update 13 -- 1.7 HOW TO USE THIS GUIDELINE? 13 -- 2 METHODS 16 -- 2.1 RESEARCH QUESTIONS 16 -- 2.1.1 Methodology 16 -- 2.1.2 Research questions, included medical treatment options and outcomes 16 -- 2.1.3 Excluded medical treatment options 17 -- 2.2 DEFINITIONS 17 -- 2.3 LITERATURE SEARCH 18 -- 2.4 SELECTION CRITERIA 18 -- 2.5 SELECTION PROCESS 19 -- 2.6 QUALITY APPRAISAL 20 -- 2.7 DATA EXTRACTION AND GRADING OF EVIDENCE 20 -- 2.8 FORMULATION OF RECOMMENDATIONS 23 -- 2.8.1 Methodology 23 -- 2.8.2 Defining and interpreting the strength of a recommendation 23 -- 2.9 EXTERNAL REVIEW 25 -- 2.10 FINAL VALIDATION 26 -- 2.11 DEVELOPMENT OF THE GUIDELINE: PROJECT TEAM, INVOLVED EXPERTS, PANEL OF STAKEHOLDERS 26 -- 3 SEARCH RESULTS 27 -- 3.1 SYSTEMATIC REVIEWS 27 -- 3.2 RANDOMIZED CONTROLLED TRIALS 29 -- 4 EVIDENCE REPORT 31 -- 4.1 INTRODUCTION 31 -- 4.1.1 Pain Assessment 31 -- 4.1.2 Pain assessment tools 31 -- 4.1.3 Severity of pain 32 -- 4.1.4 The World Health Organization analgesic ladder 33 -- 4.2 NSAIDS AND PARACETAMOL 37 -- 4.2.1 Introduction 37 -- 4.2.2 Search results 38 -- 4.2.3 Literature overview 40 -- 4.2.4 Other considerations 47 -- 4.3 OPIOIDS 51 -- 4.3.1 Introduction 51 -- 4.3.2 Search results 60 -- 4.3.3 Literature overview 63 -- 4.3.4 Other considerations 93 -- 4.4 CORTICOSTEROIDS 102 -- 4.4.1 Introduction 102 -- 4.4.2 Search results 102 -- 4.4.3 Literature overview 103 -- 4.4.4 Other considerations 104 -- 4.5 ANTIDEPRESSANTS 105 -- 4.5.1 Introduction 105 -- 4.5.2 Search results 105 -- 4.5.3 Literature overview 105 -- 4.5.4 Other considerations 107 -- 4.6 ANTICONVULSANTS 109 -- 4.6.1 Introduction 109 -- 4.6.2 Search results 109 -- 4.6.3 Literature overview 110 -- 4.6.4 Other considerations 114 -- 4.7 RADIOTHERAPY FOR PAINFUL BONE METASTASES 117 -- 4.7.1 Introduction 117 -- 4.7.2 Search results 118 -- 4.7.3 Literature overview 119 -- 4.7.4 Other considerations 123 -- 4.8 RADIONUCLIDES FOR PAINFUL BONE METASTASES 127 -- 4.8.1 Introduction 127 -- 4.8.2 Search results 128 -- 4.8.3 Literature overview 129 -- 4.8.4 Other considerations 131 -- 4.9 BISPHOSPHONATES FOR PAINFUL BONE METASTASES 133 -- 4.9.1 Introduction 133 -- 4.9.2 Search results 134 -- 4.9.3 Literature overview 136 -- 4.9.4 Other considerations 145 -- 4.10 CELIAC PLEXUS BLOCK 148 -- 4.10.1 Introduction 148 -- 4.10.2 Search results 149 -- 4.10.3 Literature overview 149 -- 4.10.4 Other considerations 150 -- 5 DISCUSSION 152 -- 5.1 PAIN IMPROVEMENT: WHAT IS A CLINICALLY IMPORTANT CHANGE? 152 -- 5.2 PREVENTION OF CANCER PAIN 153 -- 5.3 OTHER CONSIDERATIONS 154 -- 5.3.1 Scope of the report 154 -- 5.3.2 Quality of the studies 154 -- 5.3.3 Adverse events 154 -- 5.3.4 Use of pain medication in cancer patients with renal or liver impairment 154 -- 5.3.5 Combinations of interventions 154 -- 5.3.6 Aspects of costs and reimbursement of included interventions 154 -- 5.3.7 Multidisciplinary approach of pain treatment 155 -- 5.3.8 Patient-centered care 155 -- 5.3.9 Barriers and facilitators for implementation of this guideline 155 -- REFERENCES 156