Page 56 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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relief of cancer pain. Hallucinations and cognitive disturbance were
reported at higher doses of ketamine. One RCT included in the review
demonstrated twice the incidence of AEs when a rapid dose escalation
method was employed. 70, level I

In the previous guidelines, ketamine was recommended to be
considered in patients with poorly controlled cancer pain despite optimal
opioid therapy. It may be used by specialists familiar with cancer pain
management or palliative medicine/pain specialists. 9

• Ketamine is sometimes used as an adjunct to opioids in patients with
cancer pain.

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• Anticonvulsants or antidepressants may be considered in patients
with neuropathic cancer pain.
• Corticosteroids may be used cautiously as an adjuvant in patients
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• Bone targeting agents may be used in cancer patients with painful
bone metastasis.

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Medical cannabis is a term used to describe cannabis used for medical
purposes. In recent years, there has been increasing interest in the
potential therapeutic use of cannabis for various medical conditions
including chronic pain. However, there is still much debate surrounding
the issue due to concerns about its safety and effectiveness.

Evidence mapping of systematic reviews on the therapeutic effects
of medicinal cannabis reported that the evidence was broad, highly
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there was a limited number of studies that investigated cancer pain
relief by medicinal cannabis. 71, level I

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cannabis to opioid therapy: 72, level I
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CI -0.38 to 0.02) based on high certainty evidence
• increased incidence of nausea (RR=1.43, 95% CI 1.04 to 1.96)
and vomiting (RR=1.50, 95% CI 1.01 to 2.24) based on moderate
certainty evidence

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