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Incident Pain Management — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyIncident Pain ManagementSCE Medical Oncology

A 62-year-old man with advanced cancer and bone metastases develops incident pain (pain that occurs with specific activities like weight-bearing or coughing) despite adequate background analgesia. What is the best approach to incident pain?

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Correct answer: E — Rapid-onset fentanyl (buccal/sublingual/nasal) given 10-15 minutes before the precipitating activity — this provides pre-emptive analgesia for predictable incident pain; background opioid increases would cause sedation without addressing the activity-specific pain

Incident pain (a subtype of breakthrough pain triggered by specific activities) is distinct from spontaneous breakthrough pain. For PREDICTABLE incident pain (e.g. pain on weight-bearing, repositioning, dressing changes), pre-emptive rapid-onset fentanyl given 10-15 minutes before the activity provides targeted analgesia without unnecessary background opioid escalation. Transmucosal fentanyl (buccal, sublingual, nasal) has the fastest onset (~5-15 minutes). The dose is titrated independently of the background opioid. Non-pharmacological approaches (optimal positioning, orthotics, physiotherapy) complement medication.

Reference: NICE CG140 Opioids in palliative care; ESMO Pain Management; Palliative Care Formulary