Page 16 - CPG - Clinical Practice Guidelines - Management of Cancer Pain
P. 16
Management of Cancer Pain (Second Edition)
ALGORITHM 1. MANAGEMENT OF CANCER PAIN IN ADULTS
Cancer patient with pain
Assessment - History/Physical Examination/Investigation
Diagnosis
• Type - Nociceptive/Neuropathic/Mixed
• Source - Cancer-related/Non-cancer-related
• Severity - Pain Score
Pain Score
Mild Cancer Pain Moderate Cancer Pain Severe Cancer Pain
(Pain Score: 1 - 3) (Pain Score: 4 - 6) (Pain Score: 7 - 10)
WHO LADDER STEP III
• Morphine
WHO LADDER STEP II • Oxycodone
• Tramadol • Fentanyl
WHO LADDER STEP I • Codeine ± Non-opioids
± Adjuvants
• Paracetamol • Dihydrocodeine
• NSAIDs ± Non-opioids
• COX-2 inhibitors ± Adjuvants No Refer to
Pain
± Adjuvants Control Palliative
No Care Team/
Pain Pain
No Control Yes Specialist
Pain
Control
Yes
Yes
Reassessment
and Follow-up
NSAIDs: Non-steroidal anti-inflammatory drugs
COX-2: cyclooxygenase-2
*Strong opioids can be considered to treat moderate cancer pain 23, level I
Adapted: Ministry of Health, Malaysia. CPG Management of Cancer Pain.
Putrajaya: MoH; 2010.
x
e-cpg kandungan-Cancer pain 12/6/24.indd 15 09/08/2024 12:09 AM
