NCCN临床实践指南_成人癌痛(2019.V3)英文版

Version 3 2019 06 24 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Adult Cancer Pain Version 3 2019 June 24 2019 Continue NCCN org NCCN Guidelines Version 3 2019 Adult Cancer Pain Version 3 2019 06 24 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Robert A Swarm MD Chair Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Judith A Paice PhD RN Vice Chair Robert H Lurie Comprehensive Cancer Center of Northwestern University Doralina L Anghelescu MD St Jude Children s Research Hospital The University of Tennessee Health Science Center Madhuri Are MD Fred See PAIN 4 Footnote e was added Select extended release opioids may also be indicated for opioid na ve patients in rare circumstances Sub bullets 1 4 were added Oxycodone IR 5 mg with or without acetaminophen 325 mg Hydrocodone 5 mg with acetaminophen 325 mg Hydromorphone 2 mg PO Morphine IR 5 7 5 mg Pathway options were added Titrate further as needed If stable reassess efficacy and adverse effects within 1 4 weeks If pain is inadequately controlled reevaluate working diagnosis with a comprehensive pain assessment See PAIN C Consider pain specialty and or palliative care See PAIN L Consider opioid rotation if dose limiting adverse effects are noted 4th bullet was added If 3 4 doses needed per day consistently consider addition of long acting opioid 5th bullet was added For persistent pain initiate regular schedule of opioid with rescue dose as needed PAIN 4 Management of Pain in Opioid Tolerant Patients Mild Pain 1 3 2nd bullet was revised Non opioids and adjuvant therapies with short acting opioids unless these are contraindicated due to adverse effects or potential drug interactions See PAIN E 3rd bullet was added Re evaluate need for opioids and reduce if appropriate See PAIN E 5 of 13 Moderate Pain 4 7 2nd bullet was added Non opioids and adjuvant therapies as appropriate with short acting opioids as needed See PAIN E 3rd bullet was revised Titrate short acting opioid see PAIN 4 with the goal of increasing daily dose by 30 50 Pathway options were added Titrate further as needed If stable reassess efficacy and adverse effects within 1 4 weeks If pain is inadequately controlled reevaluate working diagnosis with a comprehensive pain assessment See PAIN C Consider pain specialty and or palliative care consultation See PAIN L Consider opioid rotation if dose limiting adverse effects are noted 4th bullet was added If 3 4 doses needed per day consistently consider addition of long acting opioid 5th bullet was added For persistent pain initiate regular schedule of opioid with rescue dose as needed PAIN 5 Title was changed from Initiating Short Acting Opioids In Opioid Naive Patients to Management of Pain Crisis Pain 4 moderate to severe was changed to Pain 8 severe 1st pathway last option was revised After 2 3 cycles consider IV titration and or see PAIN 6 for subsequent management and treatment see PAIN 4 and Ongoing Care PAIN 7 PAIN 5 2nd pathway last option was revised See Subsequent Pain Management Mild Pain 0 3 PAIN 6 See Ongoing Care PAIN 7 PAIN 5 3rd pathway last option was revised After 2 3 cycles see PAIN 6 for subsequent management and treatment see PAIN 4 and Ongoing Care PAIN 7 PAIN 6 4th pathway last option was revised See Subsequent Pain Management Mild Pain 0 3 PAIN 6 See Ongoing Care PAIN 7 PAIN 5 Updates in Version 1 2019 of the NCCN Guidelines for Adult Cancer Pain from Version 1 2018 include Continued Printed by Maria Chen on 6 25 2019 10 15 29 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved NCCN Guidelines Version 3 2019 Adult Cancer Pain Version 3 2019 06 24 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion UPDATES PAIN 6 Ongoing Care 1st bullet was revised If applicable convert from parenteral 9th bullet was revised Maintain communication and coordinate care with pain palliative care specialist Goals of Treatment A 2nd bullet was added to the Achieved pathway Re evaluate need for opioids and reduce if appropriate See PAIN E 5 of 13 The 2nd bullet in the Not Achieved pathway was revised Consider pain management specialty consultation PAIN L PAIN B Anxiolytics 3rd sub bullet was added Use caution when combining anxiolytic medications with other medications that have a sedating effect eg opioids http www fda gov downloads drugs drugsafety uc