What are NCCN guidelines for palliative cancer pain management in opioid-naïve patients?

Updated: Jun 01, 2019
  • Author: Winston W Tan, MD, FACP; more...
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For opioid-naïve patients, the NCCN recommends the following non–oncologic emergency pain management [6] :

  • Provide psychosocial support, including education of the patient and family
  • Reevaluate at each contact
  • Consider adjuvant analgesics for specific pain syndromes
  • Optimize integrative interventions
  • Provide a prophylactic bowel regimen for patients receiving opioid analgesics
  • Severe pain:  For acute, severe pain or pain crisis, consider hospital or inpatient hospice admission to achieve patient-specific goals for comfort and function
  • Moderate pain:  Non-opioids and adjuvant therapies as appropriate (eg, acetaminophen, nonsteroidal anti-inflammatory drugs, antidepressants, anticonvulsants), with short-acting opioids as needed; if the patient consistently requires 3-4 doses daily, consider the addition of long-acting opioid; for persistent pain, initiate a regular schedule of opioid with rescue dose as needed
  • Mild pain: First consider non-opioids and adjuvant therapies, unless these are contraindicated due to adverse effects or potential drug interactions 

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