Cancer Pain
From Anvita Health Wiki
Management
- use acetaminophen, aspirin or NSAIDs for mild to moderate pain
- if pain persists of increases, add a low-dose or low-potency opioid
- increase opioid potency or use higher dosess for persistent pain or moderate to severe pain at onset
- add adjuvant agents at any step
- topical analgesics
- corticosteroids
- anti-inflammatory
- mood elevation
- appetite stimulation
- osteolytic bone lesions
- IV bisphosphate ( pamidronate zoledronate)
- prescribe analgesics around the clock for persistent, chronic pain, rather than as needed
- do not exceed maximum doses of NSAIDs & acetaminophen
- be judicious in accounting for analgesic combinations
- acetaminophen: 4000 mg/day
- ibuprofen 2400 mg/day, naproxen 1250 mg/day
- aspirin 4000 mg/day
- do not use meperidine (even with biliary disease)
- naloxone does not reverse CNS toxicity caused by normeperidine & may actually increase neuroexcitability
- IV patient-controlled analgesia ( morphine pump) in hospitalized patients
- manage chronic pain with around-the-clock long-acting opiates plus short-acting opiates for breakthrough pain
- titrate total analgesic dose by adding the total opiate dose (long-acting + short-acting) & using this dose for the new around-the-clock long-acting opiate dose
- recognized & manage adverse effects of opiates
-
- prophylaxis with intiation of optiates
- stool softener
- stimulant laxative
- sedation
- nausea
- prutitis: antihistamines
- except for constipation, tolerance develops
- tolerance & physical-dependence is not addiction
- tolerance
More General Terms
References
- Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
- National Guideline Clearinghouse
- Intraspinal techniques for pain management in cancer patients: guideline recommendations. Program in Evidence-based Care ngc-guideline: [1]
- Cancer pain management (general). In: Guidelines on pain management. European Association of Urology ngc-guideline: [2] Pain management in urological cancers. In: Guidelines on pain management. European Association of Urology ngc-guideline: [3]
