Talk:Cancer pain

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I've just posted this article. There is more to do but I think it is comprehensive enough to justify publishing now. It needs sections on physical, surgical and psychological interventions, which I'll get to over the next fortnight if nobody beats me to it. Cancer pain#Ethical considerations is based on one UK author, so will need other views. I intend comparing the present article with a few more textbooks and modifying accordingly. --Anthonyhcole (talk) 12:53, 21 August 2011 (UTC)

These two statements from the lead section: "The category cancer pain also includes pain caused by medical interventions in the treatment of cancer" and "nearly one in two patients receive less than optimal care" need reliable sources. Axl ¤ [Talk] 21:50, 22 August 2011 (UTC)

:Sorry. I just noticed these messages. Thank you for the feedback. Any more thoughts would be very welcome. I'll check which textbook (I think possibly both) the first claim came from when I'm next at the library in a day or two. I've made the source for the second claim clear with [http://en.wikipedia.org/w/index.php?title=Cancer_pain&diff=446320893&oldid=446292325 this] edit to the body of the text. --Anthonyhcole (talk) 14:16, 23 August 2011 (UTC)

:: Thanks. Axl ¤ [Talk] 18:15, 23 August 2011 (UTC)

:::I've [http://en.wikipedia.org/w/index.php?title=Cancer_pain&action=historysubmit&diff=446942203&oldid=446933580 removed] the first claim because I'm in the library now and can't find where I saw it. One of the textbooks I'm using is out on loan, so maybe it's in there. --Anthonyhcole (talk) 08:09, 27 August 2011 (UTC)

:::: Okay, thanks. Axl ¤ [Talk] 11:06, 29 August 2011 (UTC)

In the section "Drugs", paragraph 1, dextropopoxyphene is mentioned alongside other opioids. However in my experience in the UK, dextropopoxyphene is now rarely used due to its mediocre potency, side-effects and risk of overdose. Axl ¤ [Talk] 21:56, 22 August 2011 (UTC)

:I'll follow this up when I'm next at the library. --Anthonyhcole (talk) 14:17, 23 August 2011 (UTC)

:::The source:

Schug SA & Auret K. Clinical pharmacology: Principles of analgesic drug management. In: Sykes N, Bennett MI & Yuan C-S. Clinical pain management: Cancer pain. 2nd ed. London: Hodder Arnold; 2008; pp. 112.

The next step of the ladder involves the addition of a weak opioid without discontinuation of the nonopioid. Examples of drugs within this category include codeine phosphate, dextropopoxyphene, dihydrocodeine, and tramadol.

However, a discussion on the validity of step two has been initiated, as a meta-analysis showed that the combination of NSAIDs and weak opioids produces little improvement in analgesia with an increased incidence of toxicity.^{[http://www.ncbi.nlm.nih.gov/pubmed/7989953]} This second step is currently the subject of a wide-ranging discussion with its use being questioned in terms of its pharmacological validity (e.g., low doses of a strong opioid given as an alternative in step two), its efficacy, its only "didactic" nature, and its concession to morphene-related fears ("opiophobia").

So, in the light of this I was not surprised by your comment, Axl. I've done a brief PubMed search for "cancer" and "dextropopoxyphene" but don't see anything, scanning the abstracts, that addresses the question. I'm a little loath to delete dextropopoxyphene from the list of second rung meds, but perhaps a summary of the misgivings quoted above or from a recent review addressing the usefulness of second step analgesics would be in order. Or perhaps there's a recent review on the usefulness of dextropopoxyphene. I'm going out and don't have time to look just now, but will pursue this. --Anthonyhcole (talk) 09:33, 27 August 2011 (UTC)

:::: I admit that I'm struggling to find an article that discourages the use of dextropopoxyphene specifically in the management of cancer. [http://www.ncbi.nlm.nih.gov/pubmed/17122535 Here] is a review article that shows dextropopoxyphene's weaknesses. On the other hand, its withdrawal from the EU and the US makes it an irrelevant drug anyway.

:::: I'll keep looking for sources. Axl ¤ [Talk] 12:15, 29 August 2011 (UTC)

:::::I've [http://en.wikipedia.org/w/index.php?title=Cancer_pain&action=historysubmit&diff=447424844&oldid=447353520 inserted] this into the Drugs section for now:

The usefulness of the second step is being debated in the clinical and research communities. Some are challenging the pharmacological validity of the step and, pointing to the higher toxicity and low efficacy of mild opioids, argue that they, with the possible exception of Tramadol due to its unique action, could be replaced by smaller doses of strong opioids.

{{Talk:Cancer pain/GA1}}

{{Talk:Cancer pain/GA2}}

I'm starting on an expansion of this already quite long article, based on suggestions made in the above Featured article process - and anything else that seems relevant that emerges from my reading. Once that's done, I'll break off some large chunks into daughter or other articles. --Anthonyhcole (talk · contribs · email) 12:37, 9 June 2013 (UTC)

• Palliative care
• Paraneoplastic syndromes
• Effect of long-term use of opioids
• "Total pain"

Very clever Anthony! Ok, a few comments and I might come back later.

• The lead says: "Most acute (short-term) pain is caused by treatment or diagnostic procedures, although radiotherapy and chemotherapy may produce painful conditions that persist long after treatment has ended." >> But I'm not seeing much in the article to support or develop this idea. The entire "Cause" section seems to be discussing pain induced when the tumor or cancer is active and/or during treatment. Yet that sentence in the lead suggests pain can persist after the cancer is in remission. The only other thing I find is this partial sentence in the "Epidemiology" section: "and 33 percent of patients after completion of curative treatment experience pain"

• Consider combining short stubby paragraphs

• Consider eliminating single sentence paragraphs

• Consider eliminating some of the deep subsections, particularly in the "Cause" section.

I have reviewed this once before and am happy to do so again. But - it's only a lay review - I'm not a subject expert. Still I can try to find more holes if you'd like. I think it's an important article and you've been working it for a long time. Best, Victoria (tk) 00:38, 26 June 2014 (UTC)

:Thanks, Victoria. That all looks sensible. I'll have a closer look later. --Anthonyhcole (talk · contribs · email) 01:26, 26 June 2014 (UTC)

You don't really discuss pain as an initial symptom leading to diagnosis. A varied subject but worth covering I'd have thought - brain, pancreas etc. Amost 50% of UK diagnoses of pancreatic cancer follow "attending an emergency department for non-specific abdominal pain or jaundice or both" (pubmed 22592847, p1), by which time it's normally too late of course. But the sensitivity of the brain is very helpful. I haven't asked anyone at CRUK to look at the article - would you like me to? Wiki CRUK John (talk) 11:32, 1 July 2014 (UTC)

{{Quote box |quote = [https://en.wikipedia.org/w/index.php?title=Talk:Cancer_pain&action=edit§ion=new Tell us what you think of this article.]}}I added this box with a link to Cancer pain/Comment that said something like, "We're particularly interested in hearing what's missing or wrong and whether the article is clear and readable, but your thoughts on anything would be very welcome. Click [https://en.wikipedia.org/w/index.php?title=Talk:Cancer_pain&action=edit§ion=new here] to leave your comment. You can find your comment (and others' comments) and any replies by clicking the "talk" tab at the top of the article."

That intermediate page was deleted by User:Bearcat and they removed the box from the article. I've rewritten the box, linking directly to the "New section" window for this talk page, and restored it. I'm waiting for a policy-based explanation from Bearcat. --Anthonyhcole (talk · contribs · email) 00:50, 26 June 2014 (UTC)

:I've already provided you with all the explanation that is necessary — the type of page you created is simply not done on Wikipedia, and you do not get to claim that you are entitled to make a special exception here. The existence of the talk page tab at the top of the article is all the notification that anybody requires of the existence of the talk page, and special "go to the talk page to discuss the article" notices are not created as separate subpages of the article or as special notes inside the body text, as they do not serve any substantive purpose. No other article on Wikipedia contains such a link, and there is no valid reason to make a special exemption to Wikipedia's normal practice here. Bearcat (talk) 00:54, 26 June 2014 (UTC)

::I think it's quite clever. Anthony has worked this article for a long time, it's an important article, it's a medical article and therefore requires special care, it's an article that almost certainly will be read by readers who are either undergoing treatment for cancer and experiencing cancer pain, and therefore requires extra-special care. He's asking for a review and there's nothing inherently wrong with that. Certainly it caught my attention and I commented. Personally I'd say if we need a policy, then IAR applies. Victoria (tk) 01:08, 26 June 2014 (UTC)

:::This article does not require a higher standard of care than any other article on Wikipedia — every article is supposed to be as accurate and properly sourced as it can be, with no exceptions. (Not all articles actually are, I grant you, but the standards that articles are supposed to meet is the same across the board.) So to suggest that this one requires special rules above and beyond any other article, and special types of "feedback solicitation" mechanisms different from the ones that any other article already has, simply isn't on. Bearcat (talk) 01:13, 26 June 2014 (UTC)

::::You've got it the wrong way round there Bearcat. You'll have to present a policy that outlaws that box, or get a consensus for it's removal on this page. There may be a policy somewhere here that outlaws that box - if so, I'd appreciate you pointing me to it. Please don't just remove others' work without good grounds. --Anthonyhcole (talk · contribs · email) 01:16, 26 June 2014 (UTC)

:::::No — since it differs from standard practice across other Wikipedia articles, you're the one who needs to gain a consensus that a special process should be applicable in this isolated case. There doesn't need to be an explicit policy against something for it to be a bad idea that shouldn't be pursued — it's not possible for Wikipedians to preemptively anticipate every possible thing that somebody might think a Wikipedia article should contain. Bearcat (talk) 01:23, 26 June 2014 (UTC)

::::::We'll have to agree to disagree. Everything that hasn't been done before is not banned here. If you have a problem with that box and can't point me to a policy that says it's forbidden, you'll need to persuade me and others. Please don't edit-war. You may be right, but edit-warring is not the way to convince people - use policy and/or good argument. Hope this helps. --Anthonyhcole (talk · contribs · email) 01:32, 26 June 2014 (UTC)

:::::::Not all possible contributions are valid ones that need to be left in the article pending a consensus to remove them. BLP violations, for example, have to be taken out of an article immediately, as do many other kinds of "contributions" that people might want to add to articles. Rather, since you're the one trying to create a new type of Wikipedia "contribution" that's different from what's done in any other article, you're the one who needs to gain a consensus that the work in question is a valuable and useful thing for the article to contain. I'm not the one who needs a consensus to take it out; you're the one who needs a consensus to put it in. Bearcat (talk) 01:36, 26 June 2014 (UTC)

::::::::So, Bearcat, where does it say that, in either a foundation resolution or Wikipedia policy? You've got it wrong. We can do anything we like here that supports the foundation's and en.Wikipedia's missions, it's up to those who would limit what we do here to either persuade us or point to policy. Really. There might be a resolution or policy against this somewhere. I don't know. You're the one trying to stop it. You find the foundation resolution or en.Wikipedia policy. --Anthonyhcole (talk · contribs · email) 02:44, 26 June 2014 (UTC)

:As currently configured, I think the box is not permitted under WP:TPG. The purpose of talk pages is article improvement, but the text in the box throws such a wide net ("Tell us what you think of this article") that it falls outside the TPG. If the text were changed to "Tell us how we can improve this article, based on what Wikipedia defines as a reliable source" then this particular rule-based objection goes away. NewsAndEventsGuy (talk) 02:04, 26 June 2014 (UTC)

::NewsAndEventsGuy, the invitation is deliberately broad - to encourage more than just WP:MEDRS-based suggestions. I'd like to hear ideas for illustrations, prose improvement, clearer structure, etc. as well. What about, "Tell us how we could improve this article"? --Anthonyhcole (talk · contribs · email) 02:39, 26 June 2014 (UTC)

:::I agree you should just be patient for the new feedback system to come on line. If a box exists to point at the talk page at all - on this or any other article - then to avoid disruption of the article talk page it needs to reference some version of (A) "improve" and (B) RS; because that's how talk pages work. You're trying to recruit comments from an admittedly wide audience, meaning lots of your target audience have no clue what "RS" means or how talk pages work. Ick. NewsAndEventsGuy (talk) 09:36, 26 June 2014 (UTC)

::::I'll be monitoring the talk page, NewsAndEventsGuy; if the comments are all worthless or more trouble than they're worth, I'll remove the box. There is nothing but upside for the encyclopedia here. --Anthonyhcole (talk · contribs · email) 11:40, 26 June 2014 (UTC)

;Editorial Discussion on in-text 'comment box'

:I oppose the addition of this box in to the article, it does not add to the encyclopedic content. Additionally, Wikipedia:Article feedback was disabled a few months ago and this appears to be a backdoor attempt to bring it back without establishing community consensus first. — xaosflux ^Talk 03:54, 26 June 2014 (UTC)

::I'm fairly sure the AFT was dropped by the developers, not rejected by the community. If I'm wrong, I'd appreciate a link. --Anthonyhcole (talk · contribs · email) 04:04, 26 June 2014 (UTC)

From [https://www.mediawiki.org/wiki/Article_feedback/Version_5 this page]: "A majority of editors did not find reader comments useful enough to warrant the extra work of moderating this feedback.... The consensus was that the time had come for the foundation to retire this tool. Most participants agreed that Flow is better positioned to give our readers a voice -- and that we should clear the way to make it a success. Based on these recommendations from community and team members, the foundation removed the tool on March 3, 2014."

Regarding this particular article, I disagree with Victoria. This article is not unusual; it does not deserve "special care".

I am not aware of a policy/guideline that outlaws the box, but neither is there one that endorses it. NewsAndEventsGuy is right to remind us of WP:TPG. As the message currently stands ("Tell us what you think of this article"), legitimate responses might be "I like the article" or "I don't like it". However these statements do not help to improve the article and are not appropriate for a talk page. Nevertheless, it is reasonable to expect that reader would infer that a more in-depth statement is sought.

A message such as "How can we improve this article?" clearly requests constructive criticism that is also in line with WP:TPG.

There were two main problems with Article Feedback:-

1. there were not enough editors available to deal with the large number of comments in a timely manner.
2. The signal-to-noise ratio was rather low.

With this article, Anthonyhcole is volunteering to handle the comments. Implicitly, he is also prepared to sort the chaff (e.g. "cancer suxx0rz", "I take morphine") from the wheat. Therefore I am inclined to let him go ahead with a modification of the message. Concerned editors should watch this page. Axl ¤ [Talk] 10:58, 26 June 2014 (UTC)

:Thanks for those thoughtful comments. The consensus for dropping the AFT was among the developers; there was no consensus either way, by my recollection, within the editor community. I agree, a more sharply-focussed question is better. Yes, I'll happily monitor, and respond where necessary to, talk page comments. --Anthonyhcole (talk · contribs · email) 11:33, 26 June 2014 (UTC)

e/c @Axl

:That doesn't persuade me to change my mind because

:(A) That makes the false assumption of ongoing commitment and follow through whereas actual work on part of any particular volunteer is ephemeral;

:(B) Even if Anthonyhcole were to do a perfect job, forever, at separating wheat from chaffe, this approach still impacts every other editor who has this article's talk page on their watchlist.

:(C) {{tq|"it is reasonable to expect that reader would infer that a more in-depth statement is sought"}} It is unreasonable to think readers will infer any such thing, judging from the character of comments under online news and blog postings, and even if they do manage to make the correct inference (of those things we don't come out and say), it is unreasonable to expect readers to exercise informed discipline. Thus, everyone watching the talk page gets the chaffe in their face

:(D) If consensus is against me, then solicitations for improvement ideas still needs to reference RS; otherwise you get OR and POV and SOAP and FORUM, all disruptive to the talk page.

:SUM, While I don't particularly care if that happens on this page, I do care about the precedent it would set. Recruiting knowledgeable eds is a great idea but it should be by methods vetted by the community. Still opposed.

:NewsAndEventsGuy (talk) 11:50, 26 June 2014 (UTC)

• Support allowing Anthony to trial this on this page for a couple of months. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:33, 27 June 2014 (UTC)

:*Only a couple of months? --Anthonyhcole (talk · contribs · email) 08:12, 27 June 2014 (UTC)

::: Hence "trial". Axl ¤ [Talk] 10:34, 27 June 2014 (UTC)

:::: Fair enough. I'll let you all know in a couple of months if I got any feedback. (None so far.) As for the wording, I'm happy to go with "How can we improve this article?" Anyone have a problem with that?

:::: I'd like to add an edit notice to this talk page saying, {{quote|We're particularly interested in hearing what's missing or wrong and whether the article is clear and readable, but your thoughts on anything would be very welcome. You can find your comment (and others' comments) and any replies by clicking the "talk" tab at the top of the article.}}

:::: That requires admin tools. Axl or James, does either of you know how to add an edit notice? --Anthonyhcole (talk · contribs · email) 11:45, 27 June 2014 (UTC)

::::: Sorry, I am not an admin. Axl ¤ [Talk] 11:58, 27 June 2014 (UTC)

:::::

:::::I have boldly created an edit notice for this page. If that's controversial, feel free to change or remove it if you're an admin, and to ask me or other admin to do so if you're not. Bishonen | talk 15:10, 29 June 2014 (UTC).

::::: Those of us with template-editor or account-creator privileges can edit page notices and their ilk, so I'm happy to fix any problems that might arise - just ping me. --RexxS (talk) 19:36, 29 June 2014 (UTC)

::::::Anthony asked me if I would do it but I was too skittish; for the record, let me state that I support the edit notice. Drmies (talk) 14:50, 30 June 2014 (UTC)

• I've gone ahead and removed the box since it's been over half a year and it doesn't seem to have attracted extra comments. Encouraging reader engagement and outside review is probably a good idea, but the implementation really shouldn't be specific to articles or embedded in article text. wctaiwan (talk) 20:16, 2 April 2015 (UTC)

::{{U|Wctaiwan}}: Why not? Is this opinion or policy? If policy please link. • • • Peter (Southwood) ^(talk): 09:07, 23 July 2015 (UTC)

:::I'm not sure if there's any specific policy dictating that we can't have a feedback box in article text, but it's certainly not part of our house style. In any case, the experiment was active for months and seemed not to have the desired effect. I don't see any reason to keep it around, especially since it was a) allowed only as an experiment and b) only had local consensus on this talk page. wctaiwan (talk) 06:59, 24 July 2015 (UTC)

• The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial". Huang, Shih-Tzu et al. International Journal of Nursing Studies , Volume 47 , Issue 11 , 1354 - 1362
• "Effect of music on power, pain, depression and disability". Siedliecki, Sandra L. Journal of Advanced Nursing , Volume 54 , Issue 5 , 553- 562
• "The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: a mixed methods study". Bradt, Joke Supportive Care in Cancer , Volume 23 , Issue 5 , 1261-1271
• Puetz TW, Morley CA, Herring MP. Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer. JAMA Intern Med. 2013;173(11):960-969. doi:10.1001/jamainternmed.2013.836.
• "Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial". Gutgsell, Kathy Jo et al. Journal of Pain and Symptom Management , Volume 45 , Issue 5 , 822 - 831

Anthonyhcole (talk · contribs · email) 16:33, 12 March 2016 (UTC)

"Pain in cancer may come from compressing or infiltrating nearby body parts; from treatments and diagnostic procedures; or from skin, nerve and other changes caused by a hormone imbalance or immune response. Most chronic (long-lasting) pain is caused by the illness and most acute (short-term) pain is caused by treatment or diagnostic procedures."

It gives the impression that compression is all that causer cancer-type pain. That is actually far from being the case... cancer cells many times produce substances that enhance or create pain, and the process of treating cancer can also enhance production of these substances, one of the most famous is TNF-alpha. I think TNF-aplha, pain and cancer should be in the same sentence. It isn't named Tumor Necrosis Factor for no reason. On the scale of induced pain prom pin pricking to Bene Gesserit torture box, TNF-alpha induces the latter. Specifically, it can bind and activate TRPV-5 receptors (last receptor of the temperature/pain sensing family, the one with the highest activation temperature.)

So, thus I think the whole article needs a factual correction, but I'm not doing it, the sources I'm freely quoting from, I read some two years ago. See pubmed central, however. ...the process of treatment of tick-borne diseases by antibiotics can induce similar, excruciating levels of pain as in end-stage cancer, primarily by the same TNF-alpha route. — Preceding unsigned comment added by 90.64.43.127 (talk) 19:35, 17 November 2016 (UTC)

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I would like to do some research and add information on the mechanisms of pain in the body because I think that the article is lacking in that aspect. — Preceding unsigned comment added by Fallingskies17 (talk • contribs) 17:08, 27 November 2017 (UTC)

It has been a while since this article has been reviewed, so I took a look and noticed uncited statements, including the entire "Treatment" section under "Cause". Should this article go to WP:GAR? Z1720 (talk) 14:30, 15 June 2025 (UTC)