Cancer pain emergencies: a protocol for management

Cancer is often associated with chronic pain, which can be managed by established algorithms. Cancer is also occasionally associated with sustained episodes of excruciating pain (cancer pain emergencies) that require rapid application of powerful analgesic strategies in a manner that is distinct from chronic pain management techniques. To clarify the utility of rapid opioid dose escalation in this setting, we reviewed the management of ten cancer pain emergencies in nine patients. After initial assessment, all patients were managed according to a protocol whereby intravenous boluses of opioid are administered with rapid upward titration until an effective analgesic dose is found. Using this technique, all patients had relief of their excruciating pain after a mean of 89 min (range, 4-215 min). No patient demonstrated evidence of significant toxicity. We conclude that repeated intravenous boluses of an opioid, doubling the dose every 30 min until analgesia is achieved, is effective and safe management of cancer pain emergencies. Validation of this protocol is required.