Updated SIGN clinical guideline: Pain management in adults with cancer

The Scottish Intercollegiate Guidelines Network (SIGN) updated a clinical guideline entitled “Control of pain in adults with cancer”. 

An outline of the contents (drug therapy related) in this guideline for the treatment of cancer induced pain include:

  • Principles of pain management: introduction, World Health Organization cancer pain relief programme, using the WHO ladder.
  • Treatment with non-opioid drugs: paracetamol and non-steroidal anti-inflamatory drugs, bisphosphonates, antidepressants and anticonvulsants, ketamine, topical analgesia, cannabinoids
  • Treatment with opioid drugs: choice of opioid, administration of opioids, titrating opioids, switching between strong opioids, conversion ratios control of opioid induced constipation

The WHO analgesic ladder is always present:

WHO analgesic ladder

WHO analgesic ladder step Score on numerical rating scale Analgesics of choice
1 (mild pain) <3 out of 10 paracetamol and NSAIDs
2 (mild to moderate pain) 3 to 6 out of 10 weak opioids( eg codeine or dihydrocoideine) plus paracetamol and NSAIDs
3 (severe pain) > 6 out of 10 strong opioids (eg morphine, alfentanil, diamorphine, fentanyl, hydromorphone or oxycodone) plus paracetamol and NSIDs

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