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Opening up disruptive ways of management in cancer pain: the concept of multimorphic pain

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Supportive Care in Cancer Aims and scope Submit manuscript

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.

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Acknowledgements

Support was provided by Xavier Amores M.D. and Viorica Braniste M.D. & Ph.D. (Kyowa Kirin) and Robert Campos Oriola Ph.D and Marie-Odile Barbaza MD. (Auxesia) for manuscript preparation.

Funding

This article was funded by Kyowa Kirin.

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Authors and Affiliations

  1. Oncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes, France

    Antoine Lemaire

  2. Pain Management Unit, Hospital Saint-Louis, Paris, France

    Brigitte George

  3. Pain Management Centre, Grenoble-Alpes University Hospital, Grenoble, France

    Caroline Maindet

  4. Department of Supportive Care, Institut Curie, PSL Research University, Paris, France

    Alexis Burnod

  5. Pain Management Unit, Mutualist Clinic of la Porte-de-l’Orient, Lorient, France

    Gilles Allano

  6. Anaesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France

    Christian Minello

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  1. Antoine Lemaire
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  2. Brigitte George
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  3. Caroline Maindet
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  4. Alexis Burnod
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  6. Christian Minello
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Correspondence to Antoine Lemaire.

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Conflict of interest

Antoine Lemaire reports non-financial support from Kyowa Kirin France, during the conduct of the submitted work; personal fees and non-financial support from Kyowa Kirin International, Mundi Pharma, Grunenthal and Takeda, personal fees from Mylan, and non-financial support from Kyowa Kirin France, Archimèdes Pharma, Teva, Prostrakan, outside the submitted work. Brigitte George reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Mundipharma, non-financial support from Grunenthal and Kyowa Kirin, outside the submitted work; participation to a clinical study without honoraria from Bouchara. Caroline Maindet reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Mundipharma, and non-financial support from Kyowa Kirin, Grunenthal, Hospira, Takeda, and Janssen Cilag, outside the submitted work. Alexis Burnod reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; non-financial support from Kyowa Kirin, outside the submitted work. Gilles Allano reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Grunenthal, Mundipharma and Medtronic, and non-financial support from Kyowa Kirin, outside the submitted work. Christian Minello reports non-financial support from Kyowa Kirin, during the conduct of the submitted work; personal fees and non-financial support from Takeda, and non-financial support from Kyowa Kirin, Mundi Pharma, Mylan Pharma and Grunenthal, outside the submitted work.

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Lemaire, A., George, B., Maindet, C. et al. Opening up disruptive ways of management in cancer pain: the concept of multimorphic pain. Support Care Cancer 27, 3159–3170 (2019). https://doi.org/10.1007/s00520-019-04831-z

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  • DOI: https://doi.org/10.1007/s00520-019-04831-z

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