Answer
Answer
In 2012 the European Association for Palliative Care (EAPC) updated its guidelines for the use of opioid analgesics to treat cancer pain and provided the following recommendations [10] :
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For mild to moderate pain not controlled by NSAIDs, a step II oral opioid (codeine or tramadol) may be added; a step III opioid (eg, morphine or oxycodone) may also be considered
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There is no preference among oral morphine, oxycodone, or hydromorphone as first-choice step III opioids for moderate to severe pain
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Transdermal fentanyl and buprenorphine are alternatives to oral opioids for patients unable to swallow
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Patients experiencing inadequate relief and severe adverse effects with a step III opioid may benefit from switching to an alternative opioid
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Subcutaneous delivery is the preferred alternative for patients unable to receive opioids orally or transdermally; IV infusion should be considered when subcutaneous administration is contraindicated; IV infusion is preferred for opioid titration when rapid pain control is needed
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