References

Peer-reviewed sources and recommended reading on cancer pain management and safe prescribing of opioids, including research and validation of key assessment tools.

Cancer pain & Opioid Risk statistics

  1. Paice JA, Bohlke K, Barton D, Craig DS, El-Jawahri A, Hershman DL, Kong LR, Kurita GP, LeBlanc TW, Mercadante S, Novick KLM, Sedhom R, Seigel C, Stimmel J, Bruera E. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023 Feb 1;41(4):914-930. doi: 10.1200/JCO.22.02198. Epub 2022 Dec 5. PMID: 36469839.
    Approximately 55% of patients undergoing active treatment for cancer experience pain. For patients with advanced disease, this increases to over 66%.

  2. Carmichael AN, Morgan L, Del Fabbro E. Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review. Subst Abuse Rehabil. 2016 Jun 2;7:71-9. doi: 10.2147/SAR.S85409. PMID: 27330340; PMCID: PMC4898427.
    “Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder.”

  3. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016 Jun;51(6):1070-1090.e9. doi: 10.1016/j.jpainsymman.2015.12.340. Epub 2016 Apr 23. PMID: 27112310.
    “Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients.”

Opioid Risk Assessment Tools

  1. NIDAMED: Clinical Resources. Screening Tools and Prevention. National Institute on Drug Abuse; 2023 Jan 6. Available from: https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-prevention. Accessed 2025 July 21.

  2. NIDAMED: Clinical Resources. Screening for Substance Use in the Pain Management Setting. National Institute on Drug Abuse; 2023 Nov 17. Available from: https://nida.nih.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-pain-management-setting. Accessed 2025 July 21.

  3. NIDAMED: Clinical Resources. Screening Tools and Prevention. Opioid Risk Tool - OUD (ORT-OUD). National Institute on Drug Abuse; 2021 May 6. Available from: https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/opioid-risk-tool-oud-ort-oud. Accessed 2025 July 21.

  4. Adams LL, Gatchel RJ, Robinson RC, Polatin P, Gajraj N, Deschner M, Noe C. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004 May;27(5):440-59. doi: 10.1016/j.jpainsymman.2003.10.009. PMID: 15120773.

  5. Butler SF, Budman SH, Fanciullo GJ, Jamison RN. Cross validation of the current opioid misuse measure to monitor chronic pain patients on opioid therapy. Clin J Pain. 2010 Nov-Dec;26(9):770-6. doi: 10.1097/AJP.0b013e3181f195ba. PMID: 20842012; PMCID: PMC2955853.

  6. Butler SF, Budman SH, Fernandez KC, Houle B, Benoit C, Katz N, Jamison RN. Development and validation of the Current Opioid Misuse Measure. Pain. 2007 Jul;130(1-2):144-56. doi: 10.1016/j.pain.2007.01.014. Epub 2007 May 9. Erratum in: Pain. 2009 Mar;142(1-2):169. PMID: 17493754; PMCID: PMC1950245.

  7. Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients. BMC Geriatr. 2019 Jun 24;19(1):174. doi: 10.1186/s12877-019-1182-3. PMID: 31234786; PMCID: PMC6591833.

  8. Brott NR, Peterson E, Cascella M. Opioid, Risk Tool. [Updated 2022 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553147/

  9. Edwards T, Arthur J, Joy M, Lu Z, Dibaj S, Bruera E, Zhukovsky D. Assessing risk for nonmedical opioid use among patients with cancer: Stability of the CAGE-AID questionnaire across clinical care settings. Palliat Support Care. 2023 Jul 13:1-5. doi: 10.1017/S1478951523000871. Epub ahead of print. PMID: 37439217; PMCID: PMC10787045.

  10. Gossop M, Darke S, Griffiths P, Hando J, Powis B, Hall W, Strang J. The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction. 1995 May;90(5):607-14. doi: 10.1046/j.1360-0443.1995.9056072.x. PMID: 7795497.

  11. Hinkin CH, Castellon SA, Dickson-Fuhrman E, Daum G, Jaffe J, Jarvik L. Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. Am J Addict. 2001 Fall;10(4):319-26. PMID: 11783746.

  12. Jamison RN, Martel MO, Edwards RR, Qian J, Sheehan KA, Ross EL. Validation of a brief Opioid Compliance Checklist for patients with chronic pain. J Pain. 2014 Nov;15(11):1092-1101. doi: 10.1016/j.jpain.2014.07.007. Epub 2014 Aug 1. PMID: 25092233; PMCID: PMC4253010.

  13. Jamison RN, Martel MO, Huang CC, Jurcik D, Edwards RR. Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care. J Pain. 2016 Apr;17(4):414-23. doi: 10.1016/j.jpain.2015.12.004. Epub 2015 Dec 17. PMID: 26705974.

  14. McNeely J, Wu LT, Subramaniam G, Sharma G, Cathers LA, Svikis D, Sleiter L, Russell L, Nordeck C, Sharma A, O'Grady KE, Bouk LB, Cushing C, King J, Wahle A, Schwartz RP. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med. 2016 Nov 15;165(10):690-699. doi: 10.7326/M16-0317. Epub 2016 Sep 6. PMID: 27595276; PMCID: PMC5291717.

Pain & Symptom Assessment Tools

  1. Pain Interference Scoring Manual: A brief guide to scoring the PROMIS Pain Interference instruments. HealthMeasures.net; 2023 Dec 5. Available from: https://www.healthmeasures.net/index.php?option=com_instruments&view=measure&id=222&Itemid=992. Accessed 2025 Jul 31.

  2. Symptom Assessment Tools: The Brief Pain Inventory. The University of Texas M. D. Anderson Cancer Center. Available from: https://www.mdanderson.org/research/departments-labs-institutes/departments-divisions/symptom-research/symptom-assessment-tools/brief-pain-inventory.html. Accessed 2025 Jul 24.

  3. Cleeland CS. The Brief Pain Inventory User Guide. The University of Texas M. D. Anderson Cancer Center. 2009. Available from: https://www.mdanderson.org/content/dam/mdanderson/documents/Departments-and-Divisions/Symptom-Research/BPI_UserGuide.pdf Accessed 2025 Jul 24.

  4. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x. PMID: 11556941; PMCID: PMC1495268.

  5. Labuschagne D, Palmer P, DeLaney A, Schenk K, Fitchett G. Development of the ONC-5: A quantifiable assessment of spiritual concerns for adult oncology patients. J Health Care Chaplain. 2025 Apr-Jun;31(2):111-126. doi: 10.1080/08854726.2024.2399992. Epub 2024 Sep 17. PMID: 39977485.

  6. Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016 Jan;62(1):52. doi: 10.1016/j.jphys.2015.07.001. Epub 2015 Aug 21. PMID: 26303366.

  7. Monod SM, Rochat E, Büla CJ, Jobin G, Martin E, Spencer B. The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons. BMC Geriatr. 2010 Dec 13;10:88. doi: 10.1186/1471-2318-10-88. PMID: 21144024; PMCID: PMC3017043.

  8. Watson L, Link C, Qi S, DeIure A, Chmielewski L, Hildebrand A, Barbera L. Designing and Validating a Comprehensive Patient-Reported Outcomes Measure for Ambulatory Cancer Settings: The Revised Edmonton Symptom Assessment System for Cancer. JCO Oncol Pract. 2024 Dec;20(12):1764-1775. doi: 10.1200/OP.24.00088. Epub 2024 Jul 2. PMID: 38954778; PMCID: PMC11649173.

Further Reading

  1. de la Cruz M, Reddy A, Balankari V, Epner M, Frisbee-Hume S, Wu J, Liu D, Yennuraialingam S, Cantu H, Williams J, Bruera E. The Impact of an Educational Program on Patient Practices for Safe Use, Storage, and Disposal of Opioids at a Comprehensive Cancer Center. Oncologist. 2017 Jan;22(1):115-121. doi: 10.1634/theoncologist.2016-0266. Epub 2016 Oct 14. PMID: 27742907; PMCID: PMC5313268.

  2. Del Fabbro E. Assessment and management of chemical coping in patients with cancer. J Clin Oncol. 2014 Jun 1;32(16):1734-8. doi: 10.1200/JCO.2013.52.5170. Epub 2014 May 5. PMID: 24799476.

  3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95. doi: 10.15585/mmwr.rr7103a1. PMID: 36327391; PMCID: PMC9639433.

  4. Bulls HW, Bell LF, Orris SR, Goodin BR, Liebschutz JM, Wozniak A, Merlin JS, Schenker Y. Exemptions to state laws regulating opioid prescribing for patients with cancer-related pain: A summary. Cancer. 2021 Sep 1;127(17):3137-3144. doi: 10.1002/cncr.33639. Epub 2021 May 27. PMID: 34043811; PMCID: PMC9020184.

  5. Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol. 2014 Jun 1;32(16):1739-47. doi: 10.1200/JCO.2013.52.4629. Epub 2014 May 5. PMID: 24799477; PMCID: PMC4031191.

  6. Jairam V, Yang DX, Verma V, Yu JB, Park HS. National Patterns in Prescription Opioid Use and Misuse Among Cancer Survivors in the United States. JAMA Netw Open. 2020 Aug 3;3(8):e2013605. doi: 10.1001/jamanetworkopen.2020.13605. PMID: 32804217; PMCID: PMC7431994.

  7. Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, Chwistek M, Cleeland C, Craig D, Gafford E, Greenlee H, Hansen E, Kamal AH, Kamdar MM, LeGrand S, Mackey S, McDowell MR, Moryl N, Nabell LM, Nesbit S; BCPS; O'Connor N, Rabow MW, Rickerson E, Shatsky R, Sindt J, Urba SG, Youngwerth JM, Hammond LJ, Gurski LA. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Aug 1;17(8):977-1007. doi: 10.6004/jnccn.2019.0038. PMID: 31390582.