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  • Content
  • CPCRE
  • ACRRM
  • Content
    • Introduction
    • Responses to Patient FAQs
    • Treatment tree
      • Get Started
      • Mild to Moderate Pain
      • Moderate to Severe Pain
      • Breakthrough Pain
    • Precautions When Using Opioids
    • Difficult Pain Control
    • Equianalgesic Dosing
    • Incident Pain
    • Mode of Action
    • Morphine Myths and Facts
    • Route of Delivery
  • Opioids
    • Choosing an Opioid
    • Opioid Comparative Information Table
    • Opioid Formulation Table
    • Opioids in Special Populations
    • Opioids to Avoid
  • Individual Opioids
    • Buprenorphine
    • Codeine
    • Fentanyl
    • Hydromorphone
    • Methadone
    • Morphine
    • Oxycodone
    • Tramadol
    • Tapentadol

Route of Delivery

Oral#

Preferred route of opioid delivery; as effective as parenteral opioid at equianalgesic doses.

Parenteral#

If oral route not possible (e.g. head and neck tumor, bowel obstruction, nausea/vomiting) one or more of the following routes may be appropriate

Subcutaneous#

Most opioids can be delivered by this route as a continuous infusion or by bolus dosing; methadone can be a skin irritant and must be diluted.

Intramuscular#

There is little logic for using this route as opioids are well absorbed subcutaneously.

Intravenous#

Not commonly used in palliative care; dose is equivalent to subcutaneous dose.

Transdermal#

Several opioids are available in patch formulations that are well absorbed through the skin (e.g. fentanyl {Durogesic®}, buprenorphine {Norspan®}).

Other#

Transmucosal (fentanyl lozenge {Actiq®}, buccal tablets), rectal suppositories, intranasal spray, sublingual drops.

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  • Intramuscular
  • Intravenous
  • Transdermal
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Copyright ©2021
Built by ACRRM on behalf of CPCRE

    Welcome

    Welcome to the GP Pain Help App, to help GPs manage cancer pain in their patients.

    General principles

    Opioids are the only pharmacological class of drug with the ability to control severe pain.

    Use oral route first line where possible.

    Dose regularly with controlled-release (CR) preparations, with as required (prn) immediate-release (IR) doses (1/6 daily dose) to assess analgesic requirements.

    Titrate dose against effect and toxicity – consider switching to another class of opioid if toxicity becomes dose-limiting.

    Disclaimer

    The information within this app is presented by the Centre for Palliative Care Research and Education (CPCRE) for the purpose of disseminating health information free of charge and for the benefit of the healthcare professional.

    While CPCRE has exercised due care in ensuring the accuracy of the material herein, the information provided should be treated as a guide only to appropriate practice, to be followed subject to the clinician’s judgment and the patient’s preference in each individual case.

    CPCRE does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information contained herein.

    Acknowledgement

    CPCRE acknowledges the work of Professor Janet Hardy, Associate Professor Phillip Good and the Australian College of Rural and Remote Medicine (ACRRM) in development of this pain aid for GPs.