Page 40 Acute Pain Management

15. Steroids may reduce acute pain associated with severe pharyngitis or peritonsillar
abscess (following drainage and antibiotics) (N) (Level II).
 Recurrent or persistent orofacial pain requires biopsychosocial assessment and
appropriate multidisciplinary approaches. Neuropathic orofacial pain (atypical
odontalgia, phantom pain) may be exacerbated by repeated dental procedures, incorrect
drug therapy or psychological factors (U).
Acute pain in patients with HIV infection
1. High concentration capsaicin patches, smoking cannabis and lamotrigine are effective in
SUMMARY 2. Nucleoside reverse transcriptase inhibitor (NRTIs)‐induced neuropathic pain in HIV/AIDS
treating neuropathic pain in patients with HIV/AIDS (N) (Level II).

patients is treatable with acetyl‐L‐carnitine (ALCAR) (N) (Level II).
3.
HIV/AIDS patients with a history of problematic drug use report higher opioid analgesic
use, but also more intense pain (N) (Level III‐2).
 Neuropathic pain is common in patients with HIV/AIDS (U).
 In the absence of specific evidence, the treatment of pain in patients with HIV/AIDS
should be based on similar principles to those for the management of cancer and chronic
pain (U).

 Interaction between antiretroviral and antibiotic medications and opioids should be
considered in this population (U).

Acute cancer pain
1. Oral transmucosal fentanyl is effective in treating acute breakthrough pain in cancer
patients (S) (Level I [Cochrane Review]).
2. Radiotherapy and bisphosphonates are effective treatments of acute cancer pain due to
bone metastases (N) (Level I [Cochrane Review]).
3. Opioid doses for individual patients with cancer pain should be titrated to achieve
maximum analgesic benefit with minimal adverse effects (S) (Level II).
4. Analgesic medications prescribed for cancer pain should be adjusted to alterations of
pain intensity (U) (Level III).

 Acute pain in patients with cancer often signals disease progression; sudden severe pain
in patients with cancer should be recognised as a medical emergency and immediately
assessed and treated (U).
 Cancer patients receiving controlled‐release opioids need access to immediate‐release
opioids for breakthrough pain; if the response is insufficient after 30 to 60 minutes,
administration should be repeated (U).
 Breakthrough analgesia should be one‐sixth of the total regular daily opioid dose in
patients with cancer pain (except when methadone is used, because of its long and
variable half life) (U).
 If nausea and vomiting accompany acute cancer pain, parenteral opioids are needed (U).

xl Acute Pain Management: Scientific Evidence