Background People are surviving cancer for longer and are undergoing more lines of treatments. Their survival may be complicated by chronic pain for which they can be on long-term opioids. The pitfalls of chronic opioid use are well documented in non-cancer pain. At The Christie, there are increasing referrals to the Supportive Care Team (SCT) for patients with uncontrolled pain, on high doses of opioids experiencing significant adverse effects, whilst being actively treated for cancer.
Aims Assess the response in pain levels, side effects and ability to remain on treatment following opioid reduction, and adoption of a more targeted approach to pain control.
Method A retrospective case note review was conducted. Those included had been referred with worsening chronic pain as the predominant symptom, and an opioid reduction within the initial management plan. Data was collected with an audit tool at the initial and subsequent visit.
Results Nine case notes were reviewed. The mean opioid reduction was 35% (range 20%–100%). All patients reported a reduction in their self-rated pain score with 78% reporting at least an improvement of 2 points (out of 10). All those who felt constipated reported an improvement, and 83% who reported drowsiness felt it had resolved. At 89% of clinic visits a non-opioid medication was either started or titrated. Breakthrough opioid doses were altered in all (one excluded as no documentation) with 50% having a dose reduction (average 37.25%) and 62.5% starting trans-mucosal fentanyl. There were no delays in those on active treatment.
Conclusion Reducing overall opioid dose, treating breakthrough pain as a separate entity and optimising non-opioid medications improved both pain control and the adverse effects of opioids.
Early referral to the SCT can help optimise pain control, reduce side effects and allow patients to maintain their performance status to continue treatment.
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