Practical guide to opioids and their complications in managing cancer pain. What oncologists need to know.
Approximately 60% of cancer patients experience pain, and 25% to 30% have severe pain. With some cancers, opioids will be needed before chemotherapy begins and may be more frequently prescribed than chemotherapy. Given the frequency with which pain management is necessary in cancer patients, all oncologists should be familiar with opioid prescribing principles. This article reviews the World Health Organization recommendations for analgesic therapy in this setting, as well as guidelines for opioid therapy in patients with renal failure or hepatic failure, assessment of pain, dosing strategies in both acute and chronic pain, management of opioid overdose, pain associated with dose-limiting side effects, and pain in the actively dying.
Davis
Mellar P
MP
The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio 44195, USA. davism6@ccf.org
Lasheen
Wael
W
Gamier
Pamela
P
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004351:Drug Resistance / Q000187:drug effects; D004361:Drug Tolerance; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009021:Morphine Dependence / Q000150:complications / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications* / Q000601:surgery; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology
D000701:Analgesics, Opioid; D008691:Methadone