Page 30 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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The cornerstone of cancer pain management is using pharmacological
agents to provide pain relief and improve the quality of life for the patients.
The analgesics used can be divided into three main classes, namely
opioids, non-opioids and adjuvant medications. The choice of analgesic
as well as the dose and route of administration would depend on the
type and severity of pain. Other factors to be considered include age,
co-morbidities and patient’s adherence. A combination of medications
may be used. It is essential to monitor the patient’s response to the
medication while minimising any AEs in achieving optimal pain control.

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WHO recommends the use of analgesic medicine should follow these
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principles:
• By mouth
{ Analgesic medication should be given by mouth whenever possible.
• By the clock
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around-the-clock.
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has worn off.
• For the individual
{ As each patient is unique and different, analgesic therapy should be
individualised.
{ This is based on the type of pain, response to medication, AE etc.
• Attention to detail
{ Prescription timing should consider the patient’s day and sleep
schedule.
{ Education on the use of these medications should be given including
effects and AEs.

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The 3-step World Health Organization (WHO) analgesic ladder, which
was introduced in 1986, remains useful as an educational tool but not
as a strict protocol for cancer pain treatment. 11

The WHO analgesic ladder as shown in Figure 2 consists of three
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of analgesia is based on the intensity of pain.

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