What are ESMO guidelines for palliative cancer pain management?

Updated: Jun 01, 2019
  • Author: Winston W Tan, MD, FACP; more...
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ESMO guidelines note that although oral administration is advocated, patients presenting with severe pain that needs urgent relief should be treated and titrated with parenteral opioids, usually subcutaneous or intravenous. [8]

ESMO recommendations regarding alternative strong opioids include the following:

  • Oral hydromorphone or oxycodone (immediate-release and modified-release) and oral methadone are effective alternatives to oral morphine; however, methadone should be initiated by physicians with experience and expertise in its use
  • Transdermal fentanyl and transdermal buprenorphine are best reserved for patients whose opioid requirements are stable, and are usually the treatment of choice for patients who are unable to swallow, have poor tolerance of morphine, r poor compliance
  • Buprenorphine has a role in the analgesic therapy of patients with renal impairment and undergoing hemodialysis treatment
  • Opioid switching to improve pain relief and/or drug tolerability is not supported by high-quality evidence but is frequently used in clinical practice; it requires requires familiarity with equianalgesic doses of the different opioids

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