Cancer%20pain Management

Management

Follow Up

To ensure that the selected analgesic therapy has given the patient maximum benefit with as few adverse effects as possible, reassessment of pain intensity must be done at specified intervals
Patients on long-term opioid therapy should be assessed for abuse, addiction, tolerance or dependence
Consider opioid dose reduction by 10-20% in the following situations:
- Breakthrough analgesic was rarely or never needed
- Acute pain event has been completed
- Improvement of pain control through use of non-opioid pain management therapies is evident
- Well-controlled pain in the setting of stable disease
Opioid reduction by 10-20% can be considered in patients not needing or rarely needs breakthrough analgesia, those who completed an acute pain event or response to cancer-directed therapies, or there is noted improvement in pain control with non-opioid agents
Opioid reduction by 10-25% can be considered in patients with unmanageable adverse effects and mild pain
- Re-evaluate after dose reduction and have a close follow-up to make sure there is no pain escalation or withdrawal symptoms despite the dose reduction
Opioid reduction by 50-75% is necessary in patients who have significant safety issues

Specialist Referral

Patients may be referred to a psychiatrist for psychological support, or to a substance abuse specialist for patients on long-term opioid therapy with signs of drug addiction, abuse, dependence or tolerance
Consider physical or occupational therapy consultation for advice on the use of physical modalities
Referral to a clinical nutrition specialist for nutrition consult, dietary recommendations and information on herbal, botanical and dietary supplements is recommended
Orthopedic consultation should be considered in patients experiencing pain
Referral to a pain or palliative care specialist for refractory symptoms or intractable pain or for guidance on Methadone prescribing is recommended
Consider referral to a clinical pharmacogenomics specialist to aid in drug selection and dose adjustments based on pharmacogenomic test results
- Agents for consideration include:
  - CYP2D6: Codeine, Tramadol
  - CYP2C19 and CYP2D6: Amitriptyline, Doxepin
  - CYP2C9: Celecoxib, Meloxicam, Ibuprofen

Management of MDROs in the ICU and the role of newer antimicrobial agents

Prof. David Paterson, 30 Mar 2021

Intensive care unit (ICU) patients are at risk of developing serious infections with multidrug-resistant organisms (MDROs), which require appropriate and adequate antibiotic coverage. Early empirical coverage is pivotal in saving patients’ lives. At a recent webinar co-organized by the Society of Infectious Disease (Singapore) and Pfizer, renowned Professor David Paterson, Professor of Medicine and Director, The University of Queensland Centre for Clinical Research, and Consultant Infectious Diseases Physician, Royal Brisbane and Women’s Hospital, Brisbane, Australia, discussed the role of newer antimicrobial agents, including ceftazidime-avibactam (Zavicefta) in the management of MDROs in the ICU. Dr Wong Sin Yew, Infectious Disease Physician at Gleneagles Medical Centre and Mount Elizabeth Novena Specialist Centre, Singapore, chaired the event.

ALL treatment: Current settings, future goals

Roshini Claire Anthony, 08 Jan 2021

Significant advancements in the treatment of acute lymphocytic leukaemia (ALL) in children have improved their outcomes. However, ALL treatment and eradication remain a major challenge in adults. In a recent webinar, two specialists from the US discussed current ALL treatment strategies and goals of future regimens.

Carfilzomib-based triplet regimen a potential upfront treatment for high-risk MM

Pearl Toh, 22 Oct 2020

The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.