Cancer pain: Overview

Abstract
Background: Both acupressure and acupuncture effectively alleviate pain in cancer patients. Acupuncture requires specialized practitioners and is invasive, while acupressure is noninvasive and can be self-administered. Current comparative evidence remains insufficient for clear clinical recommendations.

Aims: To investigate the relative efficacy of acupuncture versus acupressure in alleviating pain among cancer patients.

Methods: This systematic review and network meta-analysis employed a Bayesian framework. Eight major Chinese and English databases were searched from inception to March 1, 2025. Two independent reviewers screened literature, extracted data, and assessed bias in selected studies using the Risk of Bias 2 tool. Network meta-analysis was conducted using R software version 4.4.1.

Results: Thirty-seven RCTs including 3066 patients were analyzed to compare eight treatments: manual acupuncture, transcutaneous electrical acupoint stimulation, auricular acupressure, electro-acupuncture, acupoint massage, auricular acupuncture, moxibustion, and placebo. Network meta-analysis revealed auricular acupuncture provided the greatest pain score improvement compared to placebo, followed by auricular acupressure and acupoint massage.

Conclusion: Based on our analysis, we recommend auricular acupuncture, auricular acupressure, and acupoint massage for managing cancer pain. While current studies demonstrate potential benefits, limitations include concurrent pain medication use and methodological inconsistencies. Future research should include more robust, single-intervention clinical trials to definitively evaluate efficacy for oncology patients.

Abstract
Importance: There are no updated systematic reviews examining the prevalence of persistent pain among head and neck cancer survivors.

Objectives: This systematic review aims to identify the prevalence and characteristics of persistent pain across locations among head and neck cancer survivors.

Design: A systematic review and meta-analysis.

Participants: Head and neck cancer survivors with persistent pain.

Methods: It was conducted according to PRISMA guidelines on December 14th, 2023 (PROSPERO reference CRD42024494926). The MEDLINE via PubMed, Scopus, Web of Science, CINAHL, Ovid and Cochrane Library databases were searched. Studies had to report prevalence data on persistent pain in head and neck cancer survivors who completed cancer treatment at least 3 months ago. Quality of the included studies was assessed using the critical appraisal tool developed by the Joanna Briggs Institute. Statistical heterogeneity was assessed prior to perform the meta-analysis using τ2, I2, and Q. Univariate meta-regression analyses were used to examine sources of heterogeneity.

Results: 1713 records were retrieved. After removing duplicates 1385 articles were screened. Ultimately, 182 articles were assessed for full-text screening, of which 17 manuscripts were included for review. The prevalence of the studies was 31% (95% CI, 20 to 42). The meta-regression explained approximately 40% of the observed heterogeneity (R2 = 40.57).

Conclusions: This systematic review highlights that almost third of head and neck cancer survivors are under persistent pain after finishing cancer treatment. No final conclusions can be drawn as to which extent cancer location, cancer treatment, pain measurement method and timing of pain assessments could modify this prevalence. Results should be interpreted with caution since there is considerable variability in the methods.

Abstract
Background: This paper presents a collection of important topics that are not related to the other Focus papers in this AJGP issue on palliative care but are nevertheless important for clinical practice.

Objective: This article reviews the safe use of fentanyl, the proper use of buprenorphine and oxycodone-naloxone, and the potential pitfalls of equianalgesic tables.

Discussion: Sublingual and transdermal fentanyl are contraindicated in patients who are opioid-naïve. Opioid-naïve has a strict definition. Buprenorphine does not reduce the efficacy of other analgesics. Equianalgesic tables should not be followed blindly - they have many shortcomings, even if they are the best guidance we have. The benefit of combined oxycodone-naloxone products is modest in patients receiving palliative care in whom there is a higher risk of therapeutic failure and adverse effects. In summary, these are clinical topics that frequently arise when specialist input is sought but are not directly addressed in most clinical articles.