Page 49 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
{ Persistent delirium should prompt further investigation for its
causes (e.g. hypercalcaemia, sepsis and electrolytes imbalances)
whenever appropriate.
{ A dose reduction of 25% with opioid switching may resolve
delirium. Low-dose antipsychotics e.g. haloperidol may be used. 9
{ Opioid-induced myoclonus is usually mild and can be managed
by dose reduction and opioid switching. In a systematic review of
25 studies on opioid-related AEs, there was no report on
myoclonus. 54, level I Pharmacological management using
clonazepam, sodium valproate and baclofen can be considered. 9
• Pruritus
{ Puritus can occasionally occur as an AE and has been reported up
to 9%. 54, level I ,W LV PRUH FRPPRQ DIWHU QHXURD[LDO RSLRLG GHOLYHU\
{ Antihistamines can be considered and opioid switching may be
necessary if the symptom is severe.
• Other AEs
{ Opioid-induced endocrinopathy
Cancer patients are surviving longer with the advancement of
oncological management.
„ Long-term opioid treatment in surviving patients with cancer-
related pain has been shown to affect the endocrine system. 55,
level III
„ Patient education, close follow-up, use of the lowest effective
opioid dose and opioid tapering may be considered in this
patient population. 40
{ Opioid-induced hyperalgesia 56
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opioids.
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receiving opioids for the treatment of pain could become more
sensitive to certain painful stimuli.
„ Refer to pain or palliative care physicians for further
management.
The management of opioid side effects is shown in Table 5 below. Refer
to $SSHQGL[ D for 6XJJHVWHG 0HGLFDWLRQ 'RVDJHV DQG $GYHUVH
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