Antoine Lemaire1, Brigitte George2, Caroline Maindet3, Alexis Burnod4, Gilles Allano5, Christian Minello6. 1. Oncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes, France. lemaire-a@ch-valenciennes.fr. 2. Pain Management Unit, Hospital Saint-Louis, Paris, France. 3. Pain Management Centre, Grenoble-Alpes University Hospital, Grenoble, France. 4. Department of Supportive Care, Institut Curie, PSL Research University, Paris, France. 5. Pain Management Unit, Mutualist Clinic of la Porte-de-l'Orient, Lorient, France. 6. Anaesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France.
Abstract
PURPOSE: Following a series of articles reviewing the basics of cancer pain management, in this article, we develop the guiding principle of our philosophy: the concept of multimorphic pain and how to integrate it as the innovative cornerstone of supportive care in cancer. METHOD: Critical reflection based on literature analysis and clinical practice. RESULTS: This model aims to break with standard approaches, offering a more dynamic and exhaustive vision of cancer pain as a singular clinical entity, taking into account its multimorphic characteristics (cancer pain experience can and will change during cancer: aetiology, physiopathology, clinical presentation and consequences of pain) and the disruptive elements that can occur to influence its evolution (cancer evolution, concomitant treatments, pain from associated diseases, comorbidities and complications, or modifications in the environment). Our model establishes the main key stages for interdisciplinary management of cancer pain: Early, personalised management that is targeted and multimodal; Identification, including in advance, of potential disruptive elements throughout the care pathway, using an exhaustive approach to all the factors influencing pain, leading to patient and caregiver education; Optimal analgesic balance throughout the care pathway; Integration of this concept into a systemic early supportive care model from the cancer diagnosis. CONCLUSIONS: Given the difficulties still present in the management of pain in cancer, and whilst cancer is often considered as a chronic condition, the concept of multimorphic pain proposes a practical, optimised and innovative approach for clinicians and, ultimately, for patients experiencing pain.
PURPOSE: Following a series of articles reviewing the basics of cancer pain management, in this article, we develop the guiding principle of our philosophy: the concept of multimorphic pain and how to integrate it as the innovative cornerstone of supportive care in cancer. METHOD: Critical reflection based on literature analysis and clinical practice. RESULTS: This model aims to break with standard approaches, offering a more dynamic and exhaustive vision of cancer pain as a singular clinical entity, taking into account its multimorphic characteristics (cancer pain experience can and will change during cancer: aetiology, physiopathology, clinical presentation and consequences of pain) and the disruptive elements that can occur to influence its evolution (cancer evolution, concomitant treatments, pain from associated diseases, comorbidities and complications, or modifications in the environment). Our model establishes the main key stages for interdisciplinary management of cancer pain: Early, personalised management that is targeted and multimodal; Identification, including in advance, of potential disruptive elements throughout the care pathway, using an exhaustive approach to all the factors influencing pain, leading to patient and caregiver education; Optimal analgesic balance throughout the care pathway; Integration of this concept into a systemic early supportive care model from the cancer diagnosis. CONCLUSIONS: Given the difficulties still present in the management of pain in cancer, and whilst cancer is often considered as a chronic condition, the concept of multimorphic pain proposes a practical, optimised and innovative approach for clinicians and, ultimately, for patients experiencing pain.
Entities:
Keywords:
Cancer pain management; Disruptive model; Early supportive care; Interdisciplinarity; Multimorphic pain