Procedural pain in patients with cancer: a Delphi expert management consensus

Abstract

ObjectivesDiagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer.MethodsUsing a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7–9), uncertain (4–6) or inappropriate (1–3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median.ResultsWith an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients.ConclusionsThese results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.

Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

“…[135][136][137] TIRF is the treatment of choice for BTcP due to its pharmacological properties, including rapid onset, increased potency and short half-life. 4,26,138 Conversely, oral immediate-release opioids can be used to treat slow-onset or predictable BTcP. 34,35,139 Furthermore, both TIRF and oral morphine can be prescribed to manage procedural pain, administered according to their onset of action (10-15 and 30 min, respectively).…”

“…34,35,139 Furthermore, both TIRF and oral morphine can be prescribed to manage procedural pain, administered according to their onset of action (10-15 and 30 min, respectively). 138,140 In support of this, a Delphi expert management consensus recommended transmucosal fentanyl and oral morphine as the most appropriate drugs for procedural pain, 138 suitable for both outpatients and inpatients, whilst intravenous and subcutaneous morphine was deemed most appropriate for inpatients. 138…”

“…138,140 In support of this, a Delphi expert management consensus recommended transmucosal fentanyl and oral morphine as the most appropriate drugs for procedural pain, 138 suitable for both outpatients and inpatients, whilst intravenous and subcutaneous morphine was deemed most appropriate for inpatients. 138…”

“… 34 , 35 , 139 Furthermore, both TIRF and oral morphine can be prescribed to manage procedural pain, administered according to their onset of action (10–15 and 30 min, respectively). 138 , 140 …”