Page 54 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
that practitioners may consider anticonvulsants and/or antidepressants
for patients with inadequate pain relief or intolerable AEs to opioids. 11

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e.g. headache from brain metastases, abdominal pain from liver
capsule distension or intestinal obstruction and neuropathic pain from
9
spinal cord compression. A Cochrane systematic review found that
corticosteroids were more effective than controls in cancer pain for up to
one week of intervention (MD= -0.84, 95% CI -1.38 to -0.30). The most
common AEs attributed to the medication were restlessness, insomnia,
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retention, hypocalcaemia and hyperglycaemia. An improvement
in quality of life or patient well-being had also been reported. 66, level I
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establish an ideal dose, duration of therapy and route of administration
of corticosteroids for the relief of cancer pain. Therefore, it is advocated
that clinicians prescribe corticosteroids cautiously for cancer pain
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duration and discontinue early if ineffective.

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Bisphosphonates inhibit osteoclast activity and are used as supportive
treatment to prevent or delay the occurrence of skeletal-related events
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and radiotherapy to the bone, and hypercalcemia) in patients with
bone metastases. They have been found to reduce pain and analgesic
requirements in certain cases. However, the mechanism of its pain-
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ibandronate, pamidronate, risendronate, etidronate and zoledronate.
Denosumab is a monoclonal antibody that is directed against the
receptor activator of the nuclear factor kappa beta (RANK) ligand which
leads to a decrease in osteoclastogenesis and osteoclast activity,
hence reducing bone resorption. 9; 11

Three recent systematic reviews assessed the effectiveness of different
bone targeting agents in patients of various cancers [i.e. breast, prostate
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patients. 67, level I

On the other hand, a Cochrane review assessing the effects of
bisphosphonates and other bone agents in addition to anticancer
treatment found that in women with metastatic breast cancer and bone
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