Fast Five Quiz: Oncology Pain Management

Winston W. Tan, MD


July 19, 2021

Oral administration of analgesic drugs generally should be the first choice, as this strategy can be simply managed by patients and caretakers. Adverse effects may preclude their use, including severe vomiting, bowel obstruction, severe dysphagia, or severe confusion, or if poor pain control requires rapid dose escalation.

Analgesics for chronic pain should be prescribed on a regular basis rather than as needed.

For patients with more advanced cancer whose pain is not fully alleviated by some combination of opioids and nonopioid analgesics, the additive effect of the Cannabis extract nabiximols is yet to be determined. More double-blind, placebo-controlled clinical trials are needed to confirm the efficacy of various cannabis-based therapies and determine their appropriate dosage.

Fentanyl and buprenorphine are considered the safest opioids in patients with chronic kidney disease stages 4 or 5 (estimated glomerular filtration rate < 30 mL/min) and can be administered via either the transdermal or intravenous route.

Learn more about palliative management of cancer pain.


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