Page 51 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
Refer to $SSHQGL[ for *XLGH IRU 1DOR[RQH 8VH.

5HFRPPHQGDWLRQ
‡ 2SLRLG LQGXFHG VLGH HIIHFWV VKRXOG EH SURDFWLYHO\ LGHQWL¿HG DQG
treated adequately to ensure optimum cancer pain management.
‡ /D[DWLYHV VKRXOG EH SURSK\ODFWLFDOO\ SUHVFULEHG LQ SDWLHQWV ZLWK
cancer pain and on regular opioid therapy.

7ROHUDQFH DQG DGGLFWLRQ WR RSLRLGV
‡ 7ROHUDQFH WR RSLRLGV
2SLRLG WROHUDQFH LV GH¿QHG DV D ORQJ WHUP ERG\ DGDSWDWLRQ WR RSLRLGV
resulting in reduced clinical effectiveness of opioids with repeated use
at the same dose. 57

Opioid tolerance in cancer is known to be contributed by the
GRZQUHJXODWLRQ RI PX UHFHSWRUV LQ QHXURQDO FHOOV 7KH H[DFW PHFKDQLVP
is still not well understood. Persistent pain, chronic opioid administration
DQG UHGXFHG H[SUHVVLRQ RI RSLRLG UHFHSWRUV RQ FHUWDLQ W\SHV RI FDQFHU
cells are possible causes of mu-receptor downregulation.
58
Fear of opioid tolerance should not cause any hesitation to start or
LQFUHDVH RSLRLG WKHUDS\ IRU FDQFHU SDWLHQWV H[SHULHQFLQJ SDLQ +RZHYHU
when opioid doses are very high (oral morphine >600 mg/day, oral
R[\FRGRQH ! PJ GD\ RU WUDQVGHUPDO IHQWDQ\O ! PFJ KRXU
patients should be referred to a pain specialist or palliative medicine
specialist. 9

‡ $GGLFWLRQ PLVXVH RI RSLRLGV
The incidence of opioid misuse in advanced cancer patients differs
widely between studies in a recent systematic review. Particularly
among children, adolescents and young adults, misuse behaviours
were reported to range from 7% to 90%. 59, level I 1RQVSHFL¿F VXEVWDQFH
use disorders were reported to range between 2% to 35% of adults with
cancer. It is unclear if this included treatment-related opioid dependence
or misuse. 60, level I

0XOWLSOH ULVN IDFWRUV IRU RSLRLG PLVXVH RU DEXVH KDYH EHHQ LGHQWL¿HG
among patients with cancer e.g: 61
{ history of dependence or misuse of prescription drugs, illicit drugs or
alcohol prior to cancer diagnosis/treatment
{ history of binge drinking (alcohol) or peers who binge drink
{ family history of substance abuse
{ KLVWRU\ RI SV\FKLDWULF GLVRUGHU LQFOXGLQJ DQ[LHW\ GHSUHVVLRQ DWWHQWLRQ
GH¿FLW K\SHUDFWLYLW\ GLVRUGHU SRVW WUDXPDWLF VWUHVV GLVRUGHU ELSRODU
disorder or schizophrenia

33

e-cpg inside text-Cancer pain-25/5/24.indd 33 09/08/2024 12:09 AM