Page 72 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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when the pain is moderate to severe in children. The minimum interval
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opioids in the paediatric population when compared with the uncertainty
associated with the response to codeine and tramadol. Caution on the
use codeine and tramadol has been issued due to ultra metabolisers
and potential AEs. 117, level III

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Tramadol is a synthetic analgesic with unpredictable effects due to
its wide variability in metabolism. The drug has a ceiling effect. It is
unsuitable for escalating mild-moderate pain or severe pain. It has the
potential to cause side effects in children. 112

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of adult with chronic cancer pain. 112 Oral morphine is available as either
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and when the patients are unable to tolerate oral morphine. 117, level III If
the opioid requirement goes beyond 1 mg/kg/day, it is likely that the
patient will require regular morphine. 113; 115 Morphine dose should be
monitored after 24 - 48 hours of morphine use. Alternative routes of
administration should be based on clinical judgement, drug availability
and patient’s preference. The initial dose of morphine and its frequency
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Aiman is a 10-year-old boy with relapsed Acute Lymphoblastic Leukemia
with bone metastasis. He complains of generalised pain with pain score
of 6/10. He is opioid naïve with normal renal and liver function. His
weight is 20kg and he is currently at home.

Method of dose calculation:
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Breakthrough dose: 1/10 to 1/6 of daily dose (2.5 - 4 mg), can be served
1-2 hours after previous dose of morphine.

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• Oral morphine is the preferred choice for children with moderate to
severe cancer pain.

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