Page 4 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
TABLE OF CONTENTS

No. Title Page
Levels of Evidence and Formulation of Recommendation i
Key Recommendations ii
Guidelines Development and Objectives iv
Development Group vii
Review Committee viii
External Reviewers ix
Algorithm 1. Management of Cancer Pain in Adults x
Algorithm 2. Titration of Morphine for Rapid Pain Relief in xi
Adults with Severe Pain and Distress
Algorithm 3. Management of Cancer Pain in Children xii

1. INTRODUCTION 1

2. PRINCIPLES OF MANAGEMENT 3

3. DIAGNOSIS AND ASSESSMENT 5
3.1 Clinical Presentation 5
3.2 Clinical Assessment 7
3.2.1 History 7
3.2.2 Physical Examination 8
3.2.3 Investigations 8
3.3 Pain Assessment Tools 8
3.3.1 Assessment Tools for Neuropathic Pain 9
3.3.2 Comprehensive Assessment 10
3.3.3 Pain Assessment Tools in Cognitive 11
Impairment/Learning Disability

4. PHARMACOLOGICAL INTERVENTION 12
4.1 Principles of Analgesic Medicine 12
4.2 World Health Organization Analgesic Ladder 14
4.3 Non-opioids 14
4.4 Opioids 15
4.4.1 Weak opioids 15
4.4.2 Strong opioids 16
4.4.3 Opioid initiation, titration and maintenance 19
4.4.4 Breakthrough pain management 22
4.4.5 Opioid rotation 24
4.4.6 Opioids requiring special attention 26
4.4.7 Opioid use in special populations 27
4.4.8 Opioid side effects 29
4.4.9 Opioid toxicity 32
4.4.10 Tolerance and addiction to opioids 33

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