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  • Content
  • CPCRE
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  • 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

Mild to Moderate Pain

Mild to moderate pain is most commonly controlled by paracetamol and/or non-steroidal anti-inflammatory drugs (NSAIDs).

Paracetamol dose#

500-1000mg every 4-6 hours to a maximum of 4g daily.

NSAIDs#

Appropriate for mild to moderate pain related to inflammation, tissue injury, and metastatic bone pain.

Adverse effects of NSAIDs#

  • Gastrointestinal toxicity
  • Cardiovascular toxicity

Patients taking NSAIDs should have their cardiovascular risks closely monitored and actively managed. See Therapeutic Guidelines: Cardiovascular for further information.

Patients needing low dose aspirin for cardiovascular protection should continue to take it even if needing NSAIDs; they should be monitored for GI adverse effects.

Separation in time of dose is advised where NSAIDs such as ibuprofen may interfere with effect of low dose aspirin on platelets.

  • Renal toxicity

All NSAIDs can cause renal impairment. Renal toxicity is no less with COX-2-selective inhibitors.

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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.