[Standards, options and recommendations for the use of medical analgesics for the treatment of pain arising from excess nociception in adults with cancer (update 2002): opioid analgesics with the exception of morphine by mouth and the rotation].
BACKGROUND
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the federation of French Cancer Centers (FNCLCC), the 20 French cancer centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.


OBJECTIVE
To develop clinical practice guidelines for the use of opioid analgesics with the exception of oral morphine and for opioid rotation related to the treatment of nociceptive pain in adults with cancer according to the definitions of the Standards, Options and Recommendations project.


METHODS
In 1996, a working group, set up by the FNCLCC published clinical practice guidelines for pain management in adult and paediatric patients with cancer: In the light of the evolution of knowledge, and practice these guidelines need to be updated The section on "médical analgesic treatments" in the document published in 1996 was examined by the working group to identify which questions should be updated. These questions and the relevant key words were used to develop a search strategy which was used to search Medline, and for particular questions, Embase, from January 1994 to March 1999, for relevant references, published in English or French.


RESULTS
For this update, only a few randomised clinical trials were identified, and their conclusions were generally weak. Thus much of the information in this document is based on the World Health Organisation (WHO) guidelines and represents the "state of the art" on this subject in France and is supported by expert agreement. Some changes to the original SOR are presented, particularly for the prescription of new opioids and opioid rotation. The full text of this SOR is available on the FNCLCC web site (http ://www.fnclcc.fr).
Rostaing-Rigattieri
Sylvie
S
Hôpital St Antoine, Paris, France.
Rousselot
Hubert
H
Krakowski
Ivan
I
Theobald
Serge
S
Collin
Elisabeth
E
Vuillemin
Nicole
N
Balp
Laurent
L
Torloting
Gérard
G
Fergane
Bernard
B
Richard
Bruno
B
Duclos
Roseline
R
Eschalier
Alain
A
Delorme
Thierry
T
Minello
Christian
C
Toussaint
Sophie
S
Richard
Anne
A
Magnet
Marc
M
Chvetzoff
Giselle
G
Larue
François
F
Navez
Marie-Louise
ML
Collard
Olivier
O
Bonnefoi
Marie-Pierre
MP
Couturier
Monique
M
Santolaria
Nadia
N
Wagner
Jean-Philippe
JP
Fabre
Nicolas
N
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005602:France; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid