Indian Society for Study of Pain, Cancer Pain Special Interest Group Guidelines on Pharmacological Management of Cancer Pain (Part III)

Raghavendra Ramanjulu; Raghu S Thota; Arif Ahmed; Parmanand Jain; Sushma Bhatnagar; Naveen Salins; Aparna Chatterjee; Dipasri Bhattacharya

doi:10.4103/0973-1075.285694

Indian Society for Study of Pain, Cancer Pain Special Interest Group Guidelines on Pharmacological Management of Cancer Pain (Part III)

Indian J Palliat Care. 2020 Apr-Jun;26(2):191-197. doi: 10.4103/0973-1075.285694.

Authors

Raghavendra Ramanjulu¹, Raghu S Thota², Arif Ahmed³, Parmanand Jain², Sushma Bhatnagar⁴, Naveen Salins⁵, Aparna Chatterjee², Dipasri Bhattacharya⁶

Affiliations

¹ Department of Pain and Palliative Care, Cytecare Hospital, Bengaluru, Karnataka, India.
² Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
³ Department of Anaesthesia, Critical Care and Pain Management, CK Birla Hospital for Women, Gurugram, Haryana, India.
⁴ Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
⁵ Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
⁶ Department of Anaesthesiology, Critical Care and Pain, R. G. Kar Medical College, Kolkata, West Bengal, India.

Abstract

The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group, guidelines on pharmacological management of cancer pain in adults provide a structured, step-wise approach which will help to improve the management of cancer pain and to provide patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website and circulated by E-mail to all the ISSP and Indian Association of Palliative Care members. Antidepressants and/or anticonvulsants should be used to treat neuropathic cancer pain and the dose should be titrated according to the clinical response and side effects. External beam radiotherapy should be offered to all patients with painful metastatic bone pain. There is evidence on the use of ketamine in cancer neuropathic pain, but with no beneficial effect, thus it is not recommended.

Keywords: Bone pain; Cancer Pain Special Interest Group; Indian Association of Palliative Care; Indian Society for Study of Pain; WHO analgesic ladder; breakthrough pain; cancer pain management; cancer pain management guidelines; opioids.