Page 47 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
ZDV QRW VLJQL¿FDQW 7KHUHIRUH WKHUH ZDV D QHHG IRU GRVH DGMXVWPHQW IRU
PRUSKLQH DQG R[\FRGRQH 7KH DYDLODEOH HYLGHQFH ZDV KHWHURJHQHRXV
and of low quality. 52, level I

,Q WKH HDUOLHU HGLWLRQ RI 0R+ &3* RQ &DQFHU 3DLQ LW ZDV VWDWHG WKDW
all opioids should be used cautiously and at reduced doses and/or
9
reduced frequency in patients with renal and/or liver impairment.
‡ 2OGHU DGXOWV
There is paucity of data on the use of opioids in older adults with
cancer pain. Advanced age has greater vulnerability with a proportion
of this population having multiple co-morbidities. Challenges in pain
assessment, concomitant medical conditions, cognitive impairment
e.g. dementia, increasing frailty and loss of physiologic reserve may
decrease their capacity to deal with pain and its treatment effectively.
Polypharmacy and co-morbid diseases may also reduce the type of
available treatment options. 3

Effective and safe cancer pain management in older adults requires
careful assessment and individualised care.

• In older adults with cancer pain, the general principle of treatment is
to start medication at a low dose and titrate slowly.

5HFRPPHQGDWLRQ
• In the management of cancer pain for older patients or those with
renal/liver impairment:
{ All opioids should be used with caution.*
{ Adjustment in doses/frequency of opioids should be considered.

*Fentanyl is a safer opioid in renal impairment.
2SLRLG VLGH HIIHFWV
Opioids are generally well-tolerated and safe in cancer pain
9
management. In a large systematic review of 25 studies, nausea and
constipation were most common, whilst vomiting, drowsiness and dry
mouth were less frequent. 54, level I
There was a dose-effect relationship, where higher rates of AEs were
seen with higher opioid starting doses and higher doses after titration,
particularly in morphine. 54, level I Awareness of these AEs is vital to
ensure compliance and optimal pain control.

29

e-cpg inside text-Cancer pain-25/5/24.indd 29 09/08/2024 12:09 AM