NCCN临床实践指南_成人癌痛(2019.V3)英文版
99页1、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 th
2、is 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
3、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 comprehen
4、sive 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
5、 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
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