In the ICCN 2015 Abstracts Supplement, which published online with Volume 38, Issue 4 of Cancer Nursing, oral abstract O-72 was mistakenly left out. That missing abstract appears below, and the error has been noted in the online version of the supplement, which is available at http://www.cancernursingonline.com.

O-72

Opioid Titration Protocol for Managing Breakthrough Cancer Pain in Emergency Room

Hyojung Jang¹, Jeong-Hui Ok¹, Jinseon Choi², Yeon Hee Kim²

¹Cancer Emergency Room (CER), Asan Medical Center, Seoul, Korea (The Republic of), ²Department of Nursing, Asan Medical Center, Seoul, Korea (The Republic of)

Background:

1728 patients visited with uncontrolled breakthrough pain in Cancer Emergency Room (CER) in 2013. Opioid titration is an effective strategy for rapid treating pain; however, titration is generally impractical in the busy ED. This study was aimed to develop a "breakthrough cancer pain management protocol," which provides a guideline of pain assessment and opioid titration using intravenous morphine for sudden onset stage.

Methods:

A prospective study was conducted in patients with moderate to severe cancer pain (numeric rating score [NRS] > 94). Pain intensity was measured at admission, dose titration or opioid/route switching within 3 days. Doses of opioids, duration of opioid use were reported. This protocol was designed to calculate rescue dose depending on NRS score and previous used daily opioid dose. After 30 minutes of rescue dose, pain assessment was repeated. If persistent pain (NRS > 94), same dose or escalating rescue dose were provided according to NRS score. Despite first 3hrs titration with maximum 6 times of bolus rescue dose, patient with persistent pain (NRS > 94) was started morphine IV continuous infusion (starting dose and escalating dose were decided by previous daily dose) and pain assessment and escalating dose's interval are 30 minutes. This protocol mentioned cautions and action-plan with occurred undesirable event. Pilot assessment of the efficacy and tolerability of protocol was done before study.

Results:

87% of 275 was successfully managed pain using this protocol and NRS was reduced (<3). 85% of patients are controlled within 3 hours' bolus titration. The average staying time decreased 10.1 hrs (p=.004). Re-visit patient with reluctant pain within 1 week was two.

Conclusions:

This protocol was shown to be effective and tolerated for titration for mod/severe cancer pain relief in both opioid-naBve and tolerant patient. This study warrants prospective and comparative studies with larger samples for more generalized results.

Reference