Page 9 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)

• Opioids (morphine or oxycodone) for breakthrough cancer pain
should be prescribed at 1/6 to 1/12 of the 24-hour dose.
• In the management of cancer pain for older patients or those with
renal/liver impairment:
{ All opioids should be used with caution.
{ Adjustment in doses/frequency of opioids should be considered.
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treated adequately to ensure optimum cancer pain management.
• 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.
• Radiotherapy may be offered to control pain in symptomatic bone
metastasis.
{ Single-fraction external beam therapy is the preferred choice.
• Psychoeducation, psychological and spiritual interventions should
be considered in the management of cancer pain.
• Patients whose pain control is poor despite optimal pharmacological
therapy should be referred to specialists trained in interventional pain
management for consideration of the following interventions:
o coeliac plexus neurolysis for advanced pancreatic cancer pain
o superior hypogastric plexus or ganglion impar neurolysis for
advanced pelvic and perineal cancer pain
o intrathecal drug delivery system
o vertebroplasty for malignant spinal compression fractures

Cancer Pain in Children

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in children with mild cancer pain.
• Paracetamol should be used in combination with opioids as co-
analgesic unless contraindicated in children with cancer pain.
• Oral morphine is the preferred choice for children with moderate to
severe cancer pain.
• Fentanyl or oxycodone may be used as alternative analgesics in
children with moderate to severe cancer pain.

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