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 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|