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Purpose To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. Methods An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. Results A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. Recommendations Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki .

Objectives: The pain experienced by osteoarthritis (OA) patients is neither constant nor unchanging and patients experience episodes of pain exacerbations. Using an innovative web based case-crossover design, we evaluated whether psychological factors are risk factors for pain exacerbations in patients with knee OA. Methods: In a 3-months internet-based case-crossover study, participants with symptomatic knee OA were recruited and followed at 10-day intervals (control periods). Participants were also instructed to log on to the study website if they experienced a knee pain exacerbation (case periods). Pain exacerbation was defined as an increase of ≥ 2 on a participant’s numerical rating scale (0-10) from his/her usual background pain score reported at baseline visit. The periods were 10 days for affect measures and 30 days for pain coping/perceived stress measures. The relation of psychological factors to the risk of pain exacerbation was examined using conditional logistic regression. Results: Of 298 participants recruited, 149 and 54 provided both case and control periods with no overlap for examining affect and pain coping/perceived stress factors respectively. Higher negative affect (negative affect score ≥ 18: odds ratio (OR) 6.49; 95% CI 3.45-12.2) and passive coping strategies (OR 1.26; 95% CI 1.05-1.50) were associated with increased risk of pain exacerbations; while higher active coping strategies (OR 0.81; 95% CI 0.66-0.98) had a protective effect. Conclusion: The findings emphasize the need for avoidance of negative affect and passive pain coping strategies and conversely reinforce the benefit of active pain coping strategies in prevention and management of OA pain exacerbations.