ASCO GUIDELINES Bundle

Chronic Cancer Pain

ASCO GUIDELINES App Bundle brought to you fcourtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/770601

Contents of this Issue

Navigation

Page 9 of 13

10 Treatment 4. Monitor drug-related behaviors • Effectiveness (pain is described as less intense, with a relationship to dose and dosing that is expected, and the pain reduction is associated with the ability to sustain or improve physical or psychological functioning • Adverse effects • Adherence monitoring, including compliance with current analgesic and nonopioid analgesic treatments, on the basis of risk assessment Monitoring of outcomes is consistent with integration of pain management into a palliative care model 5. Respond to aberrant behaviors a. Reassess and diagnose: Realize that aberrant drug-related behaviors have a differential diagnosis and that an assessment must be performed to clarify whether behavior indicates addiction, other psychiatric condition associated with impulsive drug use, family issues, desperation or impulsivity driven by uncontrolled pain, or some combination of these factors. Also recognize that diversion is possible and assess for this behavior. b. Consider whether to continue prescribing: • If diversion is occurring or risks now exceed benefit, taper and discontinue c. If diversion is not occurring and the assessment suggests that the benefits of therapy will continue to outweigh the risk if the aberrant behaviors are stopped, restructure prescribing to increase control and adherence monitoring • Avoid agents with higher abuse liability • Prescribe small amounts at short intervals • Review prescription drug monitoring data routinely • Use pill counts • Monitor use of substances through urine/other toxicolog y screening • Require use of one pharmacy • Use written agreement • Obtain consultation from psychiatry/ addiction specialists Advanced illness does not free the clinician from the requirement of compliance with laws and regulations Adapted from Portenoy and colleagues: J Clin Oncol. 32:1662-1670, 2014 & Lancet 377:2236-2247, 2011 Table 3. Universal Precautions in Chronic Cancer Pain Management (cont'd)

Articles in this issue

Archives of this issue

view archives of ASCO GUIDELINES Bundle - Chronic Cancer Pain