# Chronic pain in cancer survivors: assessment, non-opioid treatment first and careful opioid use

Source: https://onco.cc/protocols/chronic-pain-in-cancer-survivors/  
OnCo record `chronic-pain-in-cancer-survivors` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Pain can last for years after cancer treatment. Tell your team about any pain, especially new pain, which should be checked for cancer coming back. Most long-lasting pain is best managed first with exercise, talking therapies, physiotherapy and non-opioid medicines; acupuncture helps joint pain from aromatase inhibitors. Opioids can be tried with care, because long-term use carries real risks.

## Summary

ASCO (2016) recommends screening for pain at each encounter, evaluating new pain for recurrence, a second cancer or a late effect of treatment, involving other professionals for complex needs, and using systemic non-opioid and adjuvant analgesics; a trial of opioids may be given to carefully selected survivors who do not respond to more conservative management and remain distressed or impaired, with assessment of risk and universal precautions against misuse. Many of its recommendations rest on expert consensus because high-quality evidence was scarce. The SIO-ASCO integrative guideline (2022) recommends acupuncture for aromatase inhibitor joint pain, and says acupuncture, reflexology or acupressure may be recommended for general cancer or musculoskeletal pain, hypnosis for procedural pain and massage in palliative or hospice care. For pain from active cancer or its treatment, ASCO's opioid guideline (2023) says opioids should be offered for moderate to severe pain unless contraindicated, started as needed at the lowest dose with early assessment and titration.

The Japan Society of Pain Clinicians (2025) goes further for survivors: not all survivor pain is cancer pain; pain that is not should be treated without opioids where possible, and when opioids are needed they follow the country's non-cancer chronic pain rules (up to 60 mg oral morphine equivalent a day, not above 90 mg, for a target of 3 months). It grades psychosocial approaches [1B] and exercise [1B] most highly, NSAIDs, paracetamol, gabapentinoids for cancer-related neuropathic pain and duloxetine for CIPN pain as weak recommendations [2B], and advises against long-term corticosteroids for pain [2D].

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chronic pain after cancer; persistent pain in survivors; post-treatment pain; aromatase inhibitor joint pain; opioids in cancer survivors; chronic cancer-related pain
- Tags: protocol; pain; survivorship; supportive-care

## Connected records

- protocols: [Chemotherapy nerve damage (peripheral neuropathy): assessment, dose changes and prevention](https://onco.cc/protocols/chemotherapy-induced-peripheral-neuropathy-assessment-and-prevention/), [Exercise during and after cancer treatment: assessment, dose and referral](https://onco.cc/protocols/exercise-during-and-after-cancer-treatment/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Acupuncture for aromatase-inhibitor joint pain](https://onco.cc/technologies/acupuncture-aromatase-inhibitor-arthralgia/), [Cancer pain management](https://onco.cc/technologies/pain-management/), [Clinical hypnosis for procedures, pain and hot flushes](https://onco.cc/technologies/hypnosis-cancer-care/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Massage therapy in cancer care](https://onco.cc/technologies/massage-therapy-cancer/), [Reflexology](https://onco.cc/technologies/reflexology-cancer/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- terms: [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/)

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