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Palliative cancer care - pain - Management
How should I manage pain from raised intracranial pressure?
- Consider whether a treatable underlying cause is present.
- Discuss with an oncologist regarding the need for radiotherapy.
- Use standard analgesics in a stepwise approach. For more information, see Persistent pain.
- Also consider a trial of dexamethasone at a dose of 8–16 mg daily (taken in the morning), titrated down to the lowest dose that controls symptoms:
- If the volume of tablets or injection is difficult to manage in a single dose, it is acceptable to split the dose, in which case it should be given at 8 a.m. and 12 p.m. (noon).
- Have a low threshold for considering gastroprotection with a proton pump inhibitor.
- Response to dexamethasone should be assessed after 5–7 days, but extensive cerebral oedema may take 2–3 weeks to resolve.
- If there has been no response, discontinue dexamethasone immediately.
- If there has been a benefit, review frequently and reduce to the lowest dose that controls symptoms (for example, reduce by 2 mg every fifth day).
In depth
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