Page 33 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)

• There is no high-quality evidence to support the use of paracetamol
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used at the stage of initiation of pain management, either alone or in
combination in adults and adolescents with pain related to cancer. This
depends on the clinical assessment and pain severity of the patients. 11

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Opioid analgesics are essential for the treatment of moderate to severe
cancer pain. Constipation, nausea, vomiting, drowsiness and pruritus
are common AEs of opioids.
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Weak opioids which include tramadol, dihydrocodeine and codeine are
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to moderate cancer pain. 28

Tramadol acts both as a central opiate agonist and central nervous
system reuptake inhibitor of norepinephrine and serotonin. Liver or
renal impairment may require dose adjustments because of tramadol
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reported with the use of tramadol especially with concurrent use of
other serotonergic drugs e.g. antidepressants. 29, level III

The use of tramadol is prevalent in cancer pain management although
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compared with morphine based on very low-quality evidence. Tramadol
doses ranged from 50 - 600 mg/day with the most common dose being
300 - 400 mg/day in line with the usual clinical practice. Comparisons
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information. Most of the results in this review came from an RCT in
2016 comparing weak opioids with low-dose morphine with the latter
having a higher percentage of patients achieving a reduction in pain

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