Page 73 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
F )HQWDQ\O
Transdermal fentanyl is an effective alternative to oral morphine in
FKLOGUHQ ZLWK GLI¿FXOW\ LQ VZDOORZLQJ RU WKRVH KDYLQJ LQWUDFWDEOH QDXVHD
and vomiting whose opioid requirements are stable. 115 IV fentanyl can
EH XVHG LQ FKLOGUHQ ZLWK VSHFL¿F FLUFXPVWDQFHV H J UHQDO IDLOXUH EXW
preferably this is done under specialist care. 112 Refer to 7DEOH on
suggested dose conversion ratio for conversion of oral morphine to
fentanyl patch.

G 2[\FRGRQH
2[\FRGRQH LV DQ DOWHUQDWLYH VWURQJ RSLRLG ZKLFK LV DV HIIHFWLYH DV RUDO
morphine. Refer to 7DEOH on suggested dose conversion ratio for
FRQYHUVLRQ RI RUDO PRUSKLQH WR R[\FRGRQH

5HFRPPHQGDWLRQ
‡ )HQWDQ\O RU R[\FRGRQH PD\ EH XVHG DV DOWHUQDWLYH DQDOJHVLFV LQ
children with moderate to severe cancer pain.

H 0HWKDGRQH
Methadone is only used as an alternative opioid for cancer pain
in children. However, it should only be prescribed under specialist
supervision in palliative care settings. 118, level III
For opioid AEs and their management, refer to &KDSWHU .

‡ $GMXYDQW GUXJV
Adjuvant analgesics may be used with other analgesics including
11
strong opioids in children with cancer pain. Combining drugs with
different mechanisms of action improve analgesia and decrease AEs
in the patients. This can be used at any stage of pain severity as per
Figure 3 +RZHYHU WKHUH LV LQVXI¿FLHQW HYLGHQFH RQ WKH XVH RI DGMXYDQW
analgesics in the paediatric age group.

The use of antidepressants in children has been associated with
an increased risk of suicidal ideation and behaviour. 119 However,
amitriptyline has been used in the management of pain especially bone
pain and neuropathic pain in children. 120, level III

In children, neuropathic pain can be treated with anticonvulsants
e.g. gabapentin, pregabalin and sodium valproate. It is important to
PRQLWRU XQGHVLUHG $(V H J KHDGDFKH GURZVLQHVV DQG DWD[LD ZKHQ
commencing these agents. 113

Ketamine should be used by specialists familiar with cancer pain
management in children. It is generally used in low doses. 115

55

e-cpg inside text-Cancer pain-25/5/24.indd 55 09/08/2024 12:09 AM