Topics:

Practical Guide to Opioids and Their Complications in Managing Cancer Pain

Practical Guide to Opioids and Their Complications in Managing Cancer Pain

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.

Cancer is present in 160/100,000 males and 186/100,000 females worldwide, with some variability in frequency between countries.[1] The majority of these individuals (60%) experience pain, and 25% to 30% will have severe pain.[2,3] Those with common malignancies (eg, pancreatic or lung cancer) are likely to have pain at presentation to an oncologist or with their initial diagnosis. It is also likely that with certain cancers, opioids will be needed before chemotherapy treatment is started and that opioids will be more frequently prescribed than chemotherapy.

Several myths surround the use of opioids (Table 1).[4] These either hinder optimal opioid dosing or lead to miscommunication between clinician and patient. Analgesic prescribing errors are common among clinicians, despite the wide acceptance of the World Health Organization (WHO) "three-step ladder" guidelines. In our experience, > 50% of patients will have received opioid therapy with dosing errors when first referred to palliative services. Common errors are outlined in Table 2.[5]

Pages

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.