Page 41 - CPG - Clinical Practice Guidelines - Management of Cancer Pain
P. 41

Management of Cancer Pain (Second Edition)
                  A cross-sectional study on patients with advanced  cancer reported
                  that the vast majority (89%) of patients with breakthrough  pain who
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                  scale 0 - 10) found oral IR opioid to be either effective or very effective
                  in controlling their breakthrough pain episodes. 43, level III

                  IV  opioid  titration  and bolus administration have also been used to
                  improve control of breakthrough pain. 28

                  Oral transmucosal fentanyl citrate (OTFC) which is available in Malaysia
                  as sublingual fentanyl is only indicated for breakthrough cancer pain
                  and its method of use is markedly different from other IR opioids. The
                  total OTFC dose taken cannot be used to calculate and titrate the
                  new ATC dose. Careful patient selection, titration and monitoring are
                  required to ensure its optimal use. It is not interchangeable with other
                  IR opioids. It should only be used in adults on regular strong opioids
                                                  34
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                  A non-inferiority clinical  trial did not demonstrate  fentanyl  sublingual
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                  6& PRUSKLQH  45, level I

                  In a non-randomised clinical trial on breakthrough pain, the mean pain
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                  relief and a shorter dose titration period. 46, level II-1


                  •  Rescue dose for breakthrough pain is given as often as required (up
                    to hourly). 9
                  •  ATC dose is adjusted considering the total amount of rescue dose for
                    the last 24 hours. 9



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                  •  All patients with cancer pain who are on opioids should be prescribed
                    with rescue analgesia if required to ensure optimal pain control.
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                    should be prescribed at 1/6 to 1/12 of the 24-hour dose.






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