Talk:Cancer pain

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Posted

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)

Lead statements need references

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 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 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)

Dextropopoxyphene

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.

says:

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.^[1] 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").

The authors then discuss a role for weak non-scheduled opioids due to the ease and convenience of prescription for the physician, and their greater availability and better acceptance by patients, public and government authorities, but point out that greater readiness of physicians to prescribe and patients to accept and comply are not pharmaceutical reasons but, rather, the product of poor education and social pressure. They then make a one-paragraph case for tramadol as a possible exception, based on its dual opioid and monoaminergic properties, its demonstrated efficacy in cancer pain, its specificity for neuropathic pain, and its "superior adverse effects profile in comparison to conventional opioids."

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. 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 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.

--Anthonyhcole (talk) 03:10, 30 August 2011 (UTC)

GA Review

This review is transcluded from Talk:Cancer pain/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Michaelzeng7 (talk · contribs) 16:25, 19 February 2012 (UTC) OK, this is my first ever good article review. I'm going to read this article and see whether it deserves GA status.

• The article content is good, but I think it needs to double up on images and some infoboxes. It is very well sourced, but the article looks like a drag without images. Since this is my first review, I'm going to ask for a 2nd opinion so I can learn. Thanks! --Michaelzeng7 (talk - contribs) 21:42, 22 February 2012 (UTC)
• The article also is on the Start-Class level at WikiProject Medicine. These combined should limit its GA status. ---Michaelzeng7 (talk - contribs) 02:56, 23 February 2012 (UTC)
• Please complete your review including a typo check before requesting 2nd opinion. ~~Ebe123~~ → report 11:45, 23 February 2012 (UTC)
  • If you need some help, I'm here. ~~Ebe123~~ → report 20:57, 23 February 2012 (UTC)
    • Well, I think this article fails the good article criteria because:

1. It lacks sufficient image and/or diagrams.
2. It is classified as a Start-Class article on WikiProject Medicine.
3. It does not have an infobox or the like.

The content of the article is well sourced, and I can't find any typos (if you can point some out). The article is mainly edited primarily by one person (the nominator) and maybe we should wait a bit before good article? Thank you. --Michaelzeng7 (talk - contribs) 21:18, 23 February 2012 (UTC)

• I'm a little uncertain whether there is anything else I must do at this point in time. ---Michaelzeng7 (talk - contribs) 21:19, 23 February 2012 (UTC)

Being reconized as a Start class does not prevent GA status, an infobox could/should not be added, and have you found a (many) good image(s) to be used? Also, only being edited by one person is not a reason. So if you want, put this on hold for some images and then you may decide. ~~Ebe123~~ → report 01:15, 24 February 2012 (UTC)

• Just get some images. Do I do this? --Michaelzeng7 (talk - contribs) 01:22, 24 February 2012 (UTC)

Put it on hold for 7 days so that the nominator may fix it. ~~Ebe123~~ → report 20:14, 24 February 2012 (UTC)

• To the nominator or any bold contributor: Currently, the article is in need of images and/or diagrams to meet good article criteria. Thank you. --Michaelzeng7 (talk - contribs) 20:52, 24 February 2012 (UTC)
  • Also, the Lead must be expanded to cover all the summary. ~~Ebe123~~ → report 16:41, 25 February 2012 (UTC)

Thanks for the above suggestions.

Lead. I've made these additions to cover drug and "interventional" pain management, and the major ethical obligation and dilemma associated with cancer pain management.

Images. I responded on my talk page but will paste that here to keep the discussion in one spot: Michael, I've just read through the article again and searched Google and Commons for images that might add to the readers' understanding but didn't find any. Sorry. Do GAs have to have a certain number of photos?

Thanks again. --Anthonyhcole (talk) 06:24, 26 February 2012 (UTC)

There isn't a rule that says there have to be this number of images. There just have to be enough. I'm going to do some searching myself when I have time. ---Michaelzeng7 (talk - contribs) 15:02, 29 February 2012 (UTC)

Consider adding an image at the top of the article on the right? To display prominently. That, and one more image to the article space on the left alignment should be good. --Michaelzeng7 (talk - contribs) 15:04, 29 February 2012 (UTC)

Why? --Anthonyhcole (talk) 15:21, 29 February 2012 (UTC)

Well, I think that would satisfy this image problem. It would be a good article then I presume. Just 2 more pictures. ---Michaelzeng7 (talk - contribs) 15:24, 29 February 2012 (UTC)

OK. I've found one to illustrate the nasopharynx [2] I'll keep looking. I'm not keen on having anything in the lede, actually, if that's OK. It's a pretty grim subject and I can't think of anything I'd consider appropriate. --Anthonyhcole (talk) 15:59, 29 February 2012 (UTC)

I've added some chemo bottles. [3] How's that looking? --Anthonyhcole (talk) 17:00, 29 February 2012 (UTC)

Good, now I'm looking for one last image to go with the lead and it should be good. --Michaelzeng7 (talk - contribs) 21:38, 29 February 2012 (UTC)

The problem that is definitely present is that there are not many images that correspond directly with cancer pain. So, I think that your new image is good enough, a good article it shall be? --Michaelzeng7 (talk - contribs) 21:50, 29 February 2012 (UTC)

So I think we've eliminated images as a problem, but lets talk about the lead again, the article is quite long, a some 50,000 characters. Through Wikipedia:Lead#Length do you really think the lead can be expanded further? Thanks! ---Michaelzeng7 (talk - contribs) 22:09, 29 February 2012 (UTC)

Although it's long, the article only covers a few topics, and I mention each in the lede. I guess I could go into more detail but I personally feel it gives the essentials. Did you have something in mind that you feel is missing?

Topic	Lede
Types of cancer pain: illness- and treatment-related	Cancer pain may be caused by the tumor itself or by medical interventions in the diagnosis and treatment of cancer.
Management (drugs, interventional) and barriers to good management	Pain can be eliminated or well controlled in 80–90% of cases by the use of drugs and other interventions, but nearly one in two patients receives less-than-optimal care.
Ethical considerations	Health care professionals have an ethical obligation to ensure, wherever possible, that their patients are well informed about the risks and benefits associated with their pain management options. Adequate pain management may sometimes slightly shorten a dying patient's life.
Epidemiology	Pain is a symptom frequently associated with cancer.

--Anthonyhcole (talk) 12:06, 2 March 2012 (UTC)

Yeah, I don't think one sentence each is enough. The lead should be 3 or 4 paragraphs, so consider having a sentence or 2 for each section in the article, doing a good summary of all of the content. --Michaelzeng7 (talk - contribs) 00:34, 4 March 2012 (UTC)

It's been well over 7 days, the usual time it should take to address issues in the GA review. I think it should be time to close this review. This way, your under less pressure to fix the issues, and you can always renominate it later, when you think it is great and qualifies for the criteria whole and through. I hope you understand, and I highly encourage you to renominate it once all of the issues have been fixed. Thank you! --Michaelzeng7 (talk - contribs) 00:43, 4 March 2012 (UTC)

Suggestions

The lead should be expanded to have 2 or more paragraphs. Also, the article says little in such a long thing, as noted by the nominator, this can probably be fixed. I suggest that since there are 6 sections, there should be paragraphs like this: The Pain section is short, but it covers some stuff, and should be 2 or more sentences long to form one paragraph. The lead should contain information that is already covered in the article itself. Illness-related and Treatment-related go along and should cover 1 paragraph. Management is also big, and should cover 1 paragraph, summarizing everything in the section. Finally, the first paragraph of the lead should summarize the article as a whole, and define Cancer pain in general. Make sure everything in the article is encyclopedic, something you would also expect to find in your local library's encyclopedia, and have a very nice day! Thank you! ---Michaelzeng7 (talk - contribs) 00:55, 4 March 2012 (UTC)

P.S. I encourage you renominate the article again when you think its ready. Take your time, you are no longer under pressure to fix errors.---Michaelzeng7 (talk - contribs) 00:58, 4 March 2012 (UTC)

Thanks for your advice, Michael. I've fleshed out the lead, so I'll renominate now. --Anthonyhcole (talk) 04:02, 5 March 2012 (UTC)

We do not typically label images with number 1, 2, 3, etc. Doc James (talk · contribs · email) 13:17, 15 April 2012 (UTC)

GA Review

This review is transcluded from Talk:Cancer pain/GA2. The edit link for this section can be used to add comments to the review.

Reviewer: Allens (talk · contribs) 12:50, 30 March 2012 (UTC)

On initial scan-through, no quick-fail problems seen. A few comments:

• Formatting (I may go in and fix some of these myself; most are not requirements for good-article status):

• In terms of images, it's generally preferable if they are alternating sides. Nice use of "Fig. #" references and {{anchor}} templates - I will keep this in mind for my editing of other articles.
• Image captions should not have periods unless they are full sentences.
• I generally see "side-effects" without the hyphen (it's hyphenated in the article); it's possible both ways are correct.
• Instead of "free membership required" as part of a citation's title, I advise using the {{registration required}} template after the citation.
• I would group together the lead's second and third paragraphs into one paragraph.
• On the other hand, I would put the material on cingulotomy in its own separate paragraph.
• There are a few duplicate links, which I'll fix myself shortly.
• A stylistic matter (not a requirement): I suggest putting Epidemiology at the start of the article, as a subheader under "Pain", and moving the corresponding paragraph in the lead. Allens (talk | contribs) 14:17, 30 March 2012 (UTC)
• Some of the references contain multiple citations of the same book (e.g., the Fitzgibbon text) but different pages; it would be nice if these were put into a Works Cited section with {{sfn}} references to them. I'm not sure how to do this with vcite, however. Allens (talk | contribs) 14:17, 30 March 2012 (UTC) I think Fitzgibbon & Loeser was the only culprit. --Anthonyhcole (talk) 13:11, 5 June 2012 (UTC)

• I only see information about UK laws regarding pain management and the potential hastening of death. What about laws elsewhere? There are also a few minor wording changes preferable there which I may do myself ("one philosophical justification" instead of "a philosophical justification" and "this legal approach" instead of "this approach", unless pain management professionals are philosophers in their spare time - possible...).

Can't find anything wrt US or other legal position on this. Should I remove the UK position until I've found some more national positions? I've incidentally added something about the obligation to treat pain adequately.

Countries are oblighed by international human rights law to make pain treatment available to those within their borders as a duty under the right to health, and failure to take reasonable measures to relieve the suffering of those in pain may be seen as failure to protect against cruel, inhuman and degrading treatment. The right to pain relief is affirmed in U.S. law in the Supreme Court case of Vacco v. Quill, in statute law such as California Business and Professional Code22, and in case law precedents.

which I came across in my search.

• Something about pain's impacts on patient likelihood of recovery from the cancer itself, as opposed to overall functioning, would be nice. Allens (talk | contribs) 13:09, 30 March 2012 (UTC)

I haven't encountered this yet in my reading.

• Tramadol is unusual also in typically not causing sedation; on the other hand, it also can interfere with some anti-nausea drugs. If you could find references for these two pieces of information (possibly in the tramadol article? I haven't checked, I will admit...), including them would be nice. Allens (talk | contribs) 13:22, 30 March 2012 (UTC)

I found a source for reduced sedation ( and respiratory depression) but nothing for interfering with anti-nausea treatment so have added

...with the possible exception of tramadol due to its low sedative properties and reduced potential for respiratory depression

--Anthonyhcole (talk) 13:11, 5 June 2012 (UTC)

• Is a "mild" chemotherapy sometimes used similarly to radiation therapy in treating pain? Allens (talk | contribs) 13:22, 30 March 2012 (UTC)

I haven't encountered that in my reading. --Anthonyhcole (talk) 13:11, 5 June 2012 (UTC)

@ Allens and Anthonyhcole => in my specialty, lung cancer, it is getting VERY common, and in fact in many places, is fairly standard practice, that "reduced-dose intensity" chemotherapy (with or without radiation) regimens ARE used in many palliative situations, particularly to reduce pain, increase patient performance status, and to address certain "oncologic emergencies". Examples include impending bone fracture from mets in the appendicular skeleton, spinal mets with cord compression or impending vertebral fracture, in patients with superior vena cava compression, or with involvement of the brachial plexus from Pancoast tumors (in the lung apex), and in other palliative situations, just as "off the top of my head" examples.

Some patients will respond very well (but usually transiently) to fairly low doses of chemo and/or radiation. Platinum-based drugs cisplatin (appx. 25 to 50 mg/m2, instead of 75-125 mg/m2 - but HARD to tolerate) or carboplatin (AUC=2 instead of full-dose AUC=6, and MUCH easier to tolerate) are the typical "reduced dose intensity chemo" used, and with radiation doses used on the order of 3 to 12 Grays, at 1-2 Grays per fraction, for 3 to 6 fractions, as opposed to a "full-course, curative intent-type" dose to the tumor mass in the chest and regional nodes of 45 to 60+ Grays.— Preceding unsigned comment added by Uploadvirus (talk • contribs) 9:15, 8 June 2012

That's great. Thanks, Uploadvirus. I'll check it out. --Anthonyhcole (talk) 19:50, 8 June 2012 (UTC)

I've searched Google Scholar and PubMed for "reduced dose chemotherapy" and "reduced dose intensity chemotherapy" and found some results addressing therapeutic use but none addressing palliation. Perhaps it's early days. We can't put anything in the article, though, until we see some science behind it. If anybody hears of something I'd appreciate a nudge. --Anthonyhcole (talk) 07:32, 9 June 2012 (UTC)

• It might be a good idea (only if you can find a reference pointing this out) to mention that anti-nausea drugs may be needed anyway for side effects of chemo, etc. Allens (talk | contribs) 13:22, 30 March 2012 (UTC)

I'm not sure that's pertinent to this article. --Anthonyhcole (talk) 13:11, 5 June 2012 (UTC)

• Referencing overall appears good, with the minor exception noted above. I'll do a check on a few randomly-chosen examples.
• Disambiguation links found: Hypogastric plexus; spinal nerve roots. Allens (talk | contribs) 13:09, 30 March 2012 (UTC)
• Current status summary:

GA review (see here for what the criteria are, and here for what they are not)

---

See above for other comments.

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   No problems.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   Check looks OK.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   Some mention of non-UK laws/practice is needed; aside from that, appears good.

4. It follows the neutral point of view policy.

   Fair representation without bias:

   No problems noted (I'm not aware of there being other viewpoints from professionals in the field...).

5. It is stable.

   No edit wars, etc.:

   Stable.

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   No problem except as noted above regarding alternating sides, periods.

7. Overall:

   Pass/Fail:

   Looks like a pass!

• Allens (talk | contribs) 12:50, 30 March 2012 (UTC)
  • Thanks for your advice, Allens. I've moved the epidemiology data up per your suggestion. (Not sure if I'm meant to strike that point above, I've never followed a GA review.) All of your points are pertinent and I'll address each carefully when I can get to the library, in the next few days hopefully. --Anthonyhcole (talk) 08:21, 31 March 2012 (UTC)

• Quite welcome. Either striking the point out or putting  Done by it is fine. Allens (talk | contribs) 13:14, 31 March 2012 (UTC)

• Allens, thank you again for the effort you put in here. Something's come up, though, and I have to take an indefinite Wikibreak. I'm not sure if the GA template needs adjusting or anything. Hopefully, if your good points haven't been addressed by then, I'll be able to get back to this at some point. Sorry if I've let you down. --Anthonyhcole (talk) 04:08, 10 April 2012 (UTC)

I understand completely - stuff does happen... You haven't let me down, don't worry! I may try to find some/all of the needed references, et cetera myself. Allens (talk | contribs) 05:13, 10 April 2012 (UTC)

I've done what I can here and made notes above. --Anthonyhcole (talk) 13:11, 5 June 2012 (UTC)

Thanks! It looks pretty good to me; I have asked DocJames to take a look since he was spotting some things that I wasn't. Allens (talk | contribs) 13:19, 5 June 2012 (UTC)

I'll be looking over it later today (it's currently 1:20 AM here) and coming to a conclusion. Looks good on first glance, including correcting what DocJames had spotted. Allens (talk | contribs) 05:21, 9 June 2012 (UTC)

I apologize for the delay; things came up... I see no reason that this shouldn't pass; the epidemiology section is pretty "meaty" now, for instance. Now let me remember how to declare a GA pass... Allens (talk | contribs) 11:09, 11 June 2012 (UTC)

Thanks Allen, and everybody else. --Anthonyhcole (talk) 12:14, 11 June 2012 (UTC)

Comments

1. This topic has a lot of recent literature. I am not sure why primary references are still be used? Or references more than 5-8 years old? Such as this 1993 primary research [4].

   That study was cited in Twycross & Bennett (2008), the source for that paragraph. We don't need to cite the source of their description, but I see no harm in doing so.

2. We should use people or person rather than patient.

   I was fairly careful to only use "patient" when the source was discussing patients.

3. We do not typically state the study design as done here "A 2003 review comparing studies of patients" we typically simple state the conclusions as all refs should be secondary sources.

   That seems to have been removed now.

4. There are a number of one sentence paragraphs / sections. These need to be addressed.

   I allow the thoughts contained in them, rather than the number of sentences used, to determine my paragraph breaks. Feel free to make changes if you think it will make the ideas expressed clearer.

5. Images should be placed in the section to which they apply not above it.Doc James (talk · contribs · email) 13:20, 15 April 2012 (UTC)

   That seems to have been attended to.

Thanks, James! That all looks like good advice. I'll act on it in the fullness of time. --Anthonyhcole (talk) 13:56, 15 April 2012 (UTC)

1. I corrected your link. Editors are allowed to WP:USEPRIMARY sources, but I agree that whenever possible, it would be preferable to use more current and more comprehensive sources. In this case, I'm not too worried about it, though, because the information all seems to be correct, even though the citation behind it isn't ideal. I worry far more about poor sourcing when it results in bad information getting to the reader.
2. It's not unreasonable to use "patients" here, because there are far more people with cancer than there are patients with cancer. (The difference is whether the person has been diagnosed/is seeking care for cancer. After all, 80% of 80-year-old men are "people with prostate cancer", but only about a tenth of them are "patients with prostate cancer".)
3. That's generally true for reviews, but MEDRS recommends this style for primary studies, and it's not inappropriate to identify the reviews when you're contrasting studies of significantly different quality.
4. There's no rule against single-sentence paragraphs.
5. I've fixed the image locations. This technically isn't in the Good article criteria, but I like to have WP:ACCESS compliance anyway. Perfection in image placement would also require moving the right-justified images so that they appear in the middle of multi-paragraph sections, because WP:IMAGES discourages having images appear where the reader expects to find the first word of the new section. But again, this is not something that an article can be failed over, because the GA requirements do not include this detail. WhatamIdoing (talk) 15:04, 15 April 2012 (UTC)

We are writing for a general audience. There is guidance on this point at "common pitfalls" in our manual of style Wikipedia:Manual_of_Style/Medicine-related_articles#Common_pitfalls. For medical content primary sources are not ideal per WP:MEDRS and this is consensus opinion. Thus I see this as a 2(b) issue in the GA criteria. Doc James (talk · contribs · email) 00:21, 16 April 2012 (UTC)

I don't think that using "patients" when justified necessarily connotes not writing for a general audience. How would you prefer to get around the problem that WhatamIdoing has pointed out regarding people with cancer vs patients with cancer?

Secondary references instead of primary references, when the primary references are old enough to be included in secondary references, are certainly preferable. Any suggestions for such - ideally freely available? Allens (talk | contribs) 01:11, 16 April 2012 (UTC)

All the patients with prostate cancer are people with prostate cancer. Thus I do not see a problem to get around. Just because you have not seen a doctor does not mean you do not have the disease. I have contributed to many GAs and only used the term once.

There are many secondary sources. A few

1. Induru, RR (2011 Jul). "Managing cancer pain: frequently asked questions". Cleveland Clinic journal of medicine. 78 (7): 449–64. PMID 21724928. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
2. Portenoy, RK (2011 Jun 25). "Treatment of cancer pain". Lancet. 377 (9784): 2236–47. PMID 21704873. {{cite journal}}: Check date values in: |date= (help)
3. Marcus, DA (2011 Aug). "Epidemiology of cancer pain". Current pain and headache reports. 15 (4): 231–4. PMID 21556709. {{cite journal}}: Check date values in: |date= (help)
4. Porter, LS (2011 Aug). "Psychosocial issues in cancer pain". Current pain and headache reports. 15 (4): 263–70. PMID 21400251. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
5. Sheinfeld Gorin, S (2012 Feb 10). "Meta-analysis of psychosocial interventions to reduce pain in patients with cancer". Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 30 (5): 539–47. PMID 22253460. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

I am happy to help with access.Doc James (talk · contribs · email) 01:33, 16 April 2012 (UTC)

Also would be good to follow the outline of WP:MEDMOS more closely as is done in the main article on pain. Doc James (talk · contribs · email) 01:39, 16 April 2012 (UTC)

What's the status of this review? No comments in about three weeks. Wizardman _{Operation Big Bear} 04:28, 5 May 2012 (UTC)

I'm being distracted by RL and Wikidramas. I'll attend to the above in a few days. --Anthonyhcole (talk) 09:02, 5 May 2012 (UTC)

It's been another three weeks. Can this review be wrapped up soon? BlueMoonset (talk) 04:06, 26 May 2012 (UTC)

I've placed it on hold. Allens (talk | contribs) 09:26, 26 May 2012 (UTC)

A standard hold is one week, and we're now past that. I put a note on Anthony's talk page a week ago, after you started the hold, and he said he'd get to it after Thursday. It's Monday again; he's been editing, just not here. I didn't think to leave anything for Doc James; his last edits to the article were May 7. The article's been under review for over two months at this point; perhaps it's time to give a final deadline for the outstanding issues to be addressed, if not close the review altogether. BlueMoonset (talk) 01:10, 5 June 2012 (UTC)

OK. Deadline: This Friday, 8 June 2012. Allens (talk | contribs) 01:20, 5 June 2012 (UTC)

Thanks everybody. I think I've addressed what I can of Allens' observations, and I've responded to James' comments above. If anyone wants to collapse single sentence paragraphs into multi-sentence paragraphs, go ahead. I won't because I think it's clearer this way. As far as I know the only really old sources are there because they were cited in a much later review or textbook chapter (which I cite at the end of the sentence or paragraph) and I thought readers might like to know which study they were referring to. If someone wants to remove those citations, go ahead. I won't, because I think they're useful. Thanks again for your patience and advice. --Anthonyhcole (talk) 13:40, 5 June 2012 (UTC)

Regarding old sources: I just noticed I'm citing Melzack R & Casey KL. Sensory, motivational and central control determinants of chronic pain: A new conceptual model. In: Kenshalo DR. The skin senses: Proceedings of the first International Symposium on the Skin Senses, held at the Florida State University in Tallahassee, Florida. Springfield: Charles C. Thomas; 1968. p. 423–443. for the following

The sensation of pain is distinct from the unpleasantness associated with it. For example, it is possible in some cases, through psychosurgery or drug treatment, to remove the unpleasantness from pain without affecting its intensity, and suggestion, as in hypnosis and placebo, can sometimes temporarily reduce pain's unpleasantness but leave its intensity unchanged. Some drug therapies and other interventions can remove both the sensation of pain and its unpleasantness, and certain emotional states, such as the excitement of sport or war, can produce the same effect.

I could probably find a recent iteration of that but Melzack and Casey is the seminal statement of this three-way distinction - sensory, affective and cognitive (suggestion), so I'd prefer to cite the source. It's a bit like Newton's Principia or Copernicus' De revolutionibus orbium coelestium, an oldie but a goodie. --Anthonyhcole (talk) 03:35, 6 June 2012 (UTC)

Epidemiology

This source http://books.google.ca/books?id=qmf-lgMUwkIC&pg=PA253 says 15% of those with non metastatic Ca have pain. A discussion of how much pain occurs with different procedures would also be useful http://books.google.ca/books?id=bbbJl8RqWp0C&pg=PA108 Doc James (talk · contribs · email) 19:03, 7 May 2012 (UTC)

Those are some great stats in those links. From memory, there was more interesting information in the sources I used for the epidemiology section too, that I didn't (for concision I think) include. If you don't have a problem with a meaty epidemiology section, I don't. But I can't do focussed work like this for a few days. Feel free to have your way with anything, if you want, James. --Anthonyhcole (talk) 19:32, 7 May 2012 (UTC)

No worries regarding time limits. Here there is no time limit :-) I am away on holidays for the next few weeks. Doc James (talk · contribs · email) 19:43, 7 May 2012 (UTC)

Great. By the way, above you mention I'm citing old study reports. I'm pretty sure I only cited them when the review that I cite for the whole sentence or section cites them, that is, when the best way to convey the conclusions of a review includes mentioning a couple of studies. --Anthonyhcole (talk) 19:50, 7 May 2012 (UTC)

Yes, but once again that's 15% of patients having pain, not 15% of people having pain. WP:MEDMOS#Not using careful language warns about exactly this mistake: "Do not confuse patient-group prevalence figures with those for the whole population that have a certain condition. For example: "One third of XYZ patients" is not always the same as "One third of people with XYZ", since many people with XYZ may not be seeking medical care." WhatamIdoing (talk) 19:55, 7 May 2012 (UTC)

I think I attended to that in the article. It's very late here, so I'll check in the morning. --Anthonyhcole (talk) 20:10, 7 May 2012 (UTC)

Couldn't sleep. I checked, and I haven't conflated patients and people. I think you're right, WhatamIdoing, we need to keep the distinction clear. --Anthonyhcole (talk) 20:18, 7 May 2012 (UTC)

It is probably me she is referring to.Doc James (talk · contribs · email) 20:21, 7 May 2012 (UTC)

Ah. OK. Right. The rewording of the epidemiology section should maintain that distinction. Fair enough. --Anthonyhcole (talk) 20:25, 7 May 2012 (UTC)

I haven't addressed the epidemiology. I agree, James, that it could and should be expanded per your suggestion. I don't know when I'll be well enough to confront it though. Do you think that is sufficient to disqualify the article from GA status? --Anthonyhcole (talk) 13:45, 5 June 2012 (UTC)

It would be nice to see this section improved. I will leave the final call up to the main reviewer. Hope you are feeling well soon and thus back to Wikipedia full time :-) Doc James (talk · contribs · email) 04:23, 6 June 2012 (UTC)

I'm actually in a teaching hospital at the moment, with an awesome library, so may be able to do this. We'll see. --Anthonyhcole (talk) 07:30, 6 June 2012 (UTC)

The "15% of those with non metastatic Ca have pain" claim from your first link cites a 1982 review. More recent reviews don't use the class "pain associated with metastases" because it's not possible yet to distinguish that from pain associated with advanced cancer/terminal cancer in the studies. I've added a list of the more painful cancers, and the procedures mentioned in the second book you linked to. How am I doing? --Anthonyhcole (talk) 10:39, 6 June 2012 (UTC)

Images

Other than the image of the PCA pump I am not sure the others are sufficiently relevant to the text at hand to keep in this article. Doc James (talk · contribs · email) 04:12, 6 June 2012 (UTC)

I'd prefer to keep the anatomical illustrations, as they do make quite a bit of obscure text clearer, but I'm unconcerned about the rest. --Anthonyhcole (talk) 07:33, 6 June 2012 (UTC)

Expansion

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)

Missing

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

Comments from Victoria

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)

Other actual comments

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)

Invitation to readers to comment?

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 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 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) "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,

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)

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)

References moved from beneath the {{reflist}} section

• 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 sources, needs extension/correction?

"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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Physiology of pain

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)