Oncology Pain Management Protocol

Assessment

Initial Pain Evaluation

• Use validated pain scales (NRS 0-10 or VAS)
• Document pain characteristics:
  • Location
  • Quality
  • Temporal patterns
  • Aggravating/alleviating factors

Risk Assessment

• Screen for substance abuse history
• Evaluate psychological status
• Review current medications

Treatment Algorithm

Step 1: Mild Pain (1-3/10)

1. Non-opioid analgesics:
   • Acetaminophen (max 4g/day)
   • NSAIDs if not contraindicated

Step 2: Moderate Pain (4-6/10)

1. Weak opioids:
   • Codeine
   • Tramadol
2. Continue non-opioid analgesics

Step 3: Severe Pain (7-10/10)

1. Strong opioids:
   • Morphine (first-line)
   • Hydromorphone
   • Oxycodone
2. Calculate proper dosing:
   • Start low, titrate slowly
   • Consider breakthrough dosing (10-15% of total daily dose)

Adjuvant Medications

• Antidepressants for neuropathic pain
• Anticonvulsants for nerve compression
• Corticosteroids for inflammatory pain
• Bisphosphonates for bone metastases

Monitoring

Regular Assessment

• Pain scores q4h minimum
• Side effects monitoring
• Function improvement

Documentation Requirements

• Pain scores
• Medication responses
• Side effects
• Plan adjustments

Special Considerations

• Implement prophylactic bowel regimen
• Monitor for respiratory depression
• Address breakthrough pain
• Consider palliative care referral

Emergency Protocols

Severe Uncontrolled Pain

1. Immediate assessment
2. IV opioid consideration
3. Specialist consultation

Opioid Toxicity

1. Stop opioids
2. Support respiration
3. Naloxone protocol if needed