Cancer pain emergencies: A protocol for management

Abstract

Cancer is often associated with chronic pain, which can be managed by established algorithms. Cancer is also occasionally associated with sustained episodes of excruciating pain (cancer pain emergencies) that require rapid application of powerful analgesic strategies in a manner that is distinct from chronic pain management techniques. To clarify the utility of rapid opioid dose escalation in this setting, we reviewed the management of ten cancer pain emergencies in nine patients. After initial assessment, all patients were managed according to a protocol whereby intravenous boluses of opioid are administered with rapid upward titration until an effective analgesic dose is found. Using this technique, all patients had relief of their excruciating pain after a mean of 89 min (range, 4-215 min). No patient demonstrated evidence of significant toxicity. We conclude that repeated intravenous boluses of an opioid, doubling the dose every 30 min until analgesia is achieved, is effective and safe management of cancer pain emergencies. Validation of this protocol is required.

Opioid Dose Titration for Severe Cancer Pain: A Systematic Evidence-Based Review

“…Nine trials were identified from the search criteria, including eight prospective and one retrospective trial [7][8][9][10][11][12][13][14][15] (Table 1). Six trials were singlearm trials (Class D) and two trials were randomized (Class A).…”

“…The trial by Hagen et al 7 was a prospective pilot study of nine subjects, mean age 50 (range, 31 to 70 years). Pain was assessed using a numeric rating scale (0-10).…”

A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

“…Hagen et al . [18] and Soares et al . [19] used IV morphine and fentanyl intermittent boluses respectively to achieve successful pain control in ED.…”

Kenntnisse angehender Notfallmediziner über die Tumorschmerztherapie bei Palliativpatienten

“…Originalien Tumorerkrankungen gehen oftmals mit akuten und chronischen Schmerzen ein her [8,9,16,17]. Bis zu 90% aller Patien ten mit Tumorerkrankungen im palliati ven Krankheitsstadium (fehlender kura tiver Therapieansatz) haben insbesonde re in der letzten Lebensphase akute Symp tomexazerbationen, die sich zu einer sog.…”

“…palliativmedizinischen Notfallsituation entwickeln können [4,6,9,10,16,17,18,21,24,27,30]. Diese beruhen häufig auf einem Fortschreiten der Grunderkrankung und können ursächlich tumorbedingt, tumor assoziiert, therapiebedingt oder tumorun abhängig sein [8,9,17,18,24]. Ein effek tives Management von Tumorschmerzen erfordert in diesem Zusammenhang eine entsprechende Ausbildung und klinische Erfahrung [18].…”