National Comprehensive Cancer Network approach to management of cancer pain that is not related to oncologic emergency
The first step is to determine whether the patient is opioid naïve or opioid tolerant. In opioid naïve patients, consider titration of appropriate pharmacologic analgesics such that the dose relieves pain throughout the dosing interval but does not cause unmanageable adverse events. Titration must utilize caution in patients with risk factors: decreased hepatic or renal function, chronic lung disease, upper airway compromise, obstructive sleep apnea, or compromised cognitive and/or physical function.
Oral routes of administration are preferred; however, consider alternate routes (topical, transdermal, subcutaneous, or intravenous) to maximize comfort. Patient referrals should be considered for those who may benefit from nerve block, in those in whom adequate analgesia cannot be obtained or who are experiencing intolerable side effects. Consider interventional strategies (regional infusions such as epidural, intrathecal, or regional plexus blocks, as well as kyphoplasty, neurodestructive procedures, neurostimulation procedures, or radiofrequency ablation) if it is determined that they may provide sufficient benefit.