Page 8 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
KEY RECOMMENDATIONS

The CPG Development Group highlighted the following
recommendations as the key clinical recommendations that should be
prioritised for implementation.

Cancer Pain in Adults
• Diagnosis and Assessment

• Accurate and comprehensive assessment should be performed prior
to treatment in all patients with cancer pain.
• Appropriate pain assessment tools should be used regularly on
patients with cancer pain and documented accordingly.
{ The preferred unidimensional tools are the Visual Analogue Scale,
Numerical Rating Scale, Verbal Rating Scale and Faces Pain
Scale.

• Pharmacological Intervention

• The treatment of cancer pain should be based on the World Health
Organization (WHO) analgesic ladder.
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mild cancer pain (Step 1 of the World Health Organization analgesic
ladder).
• Weak opioids may be used for moderate pain (step 2 of the WHO
analgesic ladder) in cancer pain.
• Oral morphine is the preferred choice in moderate to severe cancer
pain.
{ Immediate-release oral morphine should be made available in all
healthcare facilities.
• Oxycodone and fentanyl can be used as alternatives to morphine.
• Transdermal fentanyl should only be used when opioid requirements
are stable.
• Patients with persistent cancer pain should be prescribed with regular
(around-the-clock) analgesia.
{ Opioid doses must be titrated to achieve optimal pain relief with
minimal adverse events.
{ Long-acting opioid formulations may be considered for patients
once the effective opioid dose has been established.
• All patients with cancer pain who are on opioids should be prescribed
with rescue analgesia if required to ensure optimal pain control.

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