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The following module was designed to supplement medical students’ learning in the clinic. Please take the time to read through each section by clicking the headings below. Information on prevalence, classification, syndromes, assessment of cancer pain along with principles of pain management is provided. By the end of the tutorial, the following objectives should be addressed:
1. Describe the prevalence of pain in cancer patient
2. Describe evidence-based screening practices for cancer pain
3. Classify and differentiate between nociceptive, neuropathic, and nociplastic pain
4. Recognize tumour-related acute and chronic cancer pain syndromes
5. Describe an approach to assessing suspected cancer pain based upon history, physical exam, and additional investigations
6. Understand how to use the WHO pain ladder to choose analgesic medication appropriate to pain level, and when it is appropriate to diverge from it
7. Understand various etiologies of pain, including reversible vs irreversible causes
8. Understand the use of non-opioid and adjuvant analgesics in cancer pain control
9. Identify opioid analgesic options, including first-line medications and routes of administration
10. Understand the indications for immediate-release opioid preparations, extended-release opioid preparations, and breakthrough opioid preparation.
11. Describe opioid dose titration best practices
12. Understand indications and principles of opioid rotations
13. Recognize common side effects of opioid therapy, along with principles of prevention and treating opioid-induced side effects
14. Recognize common criteria for when modifications to opioid therapy are warranted, including the opioid type or route of administration
15. Recognize the importance of adjuvant analgesic agents and common indications
16. Understand the limitations of cannabis in managing pain, depression, anxiety, and insomnia in cancer
17. Understand principal methods of interventional and other non-pharmacological approaches to pain management
Pain management is an important part of oncology care, with pain being a significant cause of patient morbidity. Most patients with advanced cancer and up to 60% of patients with any stage of the disease will experience significant pain, and 38% will report moderate-to-severe pain [1,2]. Pain prevalence and severity increases with disease severity, ranging from 33% in patients after curative treatment, 59% in patients on anticancer treatment, and 64% in patients with metastatic, advanced, or terminal disease [2].
As a result, there has been a growing movement in recent years to improve pain assessment and management in oncologic patients. Many major national and international organizations have produced guidelines for the screening, assessment, and management of pain in patients with cancer. This includes the National Comprehensive Cancer Network (NCCN), European Society for Medical Oncology (ESMO), and the American Society of Clinical Oncology (ASCO) [3,4,5]. Overall, there is strong consensus between these guidelines but minor recommendation variations exist. This has yielded meaningful decreases in pain prevalence and severity; in the 2014-2021 period the overall prevalence of pain dropped to 44.5% and moderate-to-severe pain was experienced by 30.6% of patients [6].
The NCCN, ASCO and ESMO guidelines all recommend that cancer patients should be screened for pain at every healthcare visit [1,2,3]. ESMO recommends using validated tools such as the Visual Pain Analogue Scale, Verbal Pain Rating Scale, and the Numerical Pain Rating Scale shown in Figure 1. It is important to screen patients for both current pain and average pain since the last pain assessment as pain may not be present at every visit. It is also important to not assume that someone’s pain will improve if they are responding to treatment, because many treatments can also cause significant pain.
The guidelines do have variations in what is considered a significant screening test. The NCCN recommends proceeding to a full assessment if a patient scores above 0, while the ESMO cut-off for a full pain assessment is a score >= 3. Clinicians should use their best judgement when deciding to conduct a full pain assessment or not, but this decision should be informed by the patient's experience of the pain. If the patient reports any pain causing distress or impairments in functioning such as work, interpersonal relationships, or sleep, a full pain assessment would be indicated regardless of how low the pain score is.
Patients with severe cognitive impairments, such as dementia, may have difficulty completing these screening tools. In these cases ESMO recommends that practitioners rely more heavily on validated observational scales for pain assessment. These often include evaluating facial expression, body movements, and vocalisations to identify the presence of pain.
Historically, the pathophysiologic classifications of acute and chronic pain have focused on neuropathic and nociceptive pain. Recent research has revealed nociplastic pain as a distinct and significant mechanism of chronic pain however, with the NCCN and the International Association for the Study of Pain (IASP) acknowledging its importance [1,2]. It is important to recognize and distinguish between these different causes of pain because treatment options differ for each. It is also important to note that most patients with advanced cancer will have at least 2 types of pain, and therefore can present with multiple classifications at once.
There are also a variety of pain syndromes in cancer that ASCO recommends care providers be familiar with. These can be organized into acute and chronic categories, which can be further subdivided into tumour-related and iatrogenic [4]. Iatrogenic syndromes are vast, varying across chemotherapy agents, hormone therapy, radiation modalities, surgical interventions, and more. Therefore, a comprehensive list is out of the scope of this article, but it is valuable to note that the most common pain syndromes associated with chemotherapy are oral mucositis and polyneuropathy, while mononeuropathy is rare.
A comprehensive pain assessment should include a medical history, psychosocial evaluation, physical exam, and further investigations as indicated, with the endpoint being a diagnosis of the pathophysiology and etiology of the pain.
1. History-Taking
It is useful to inquire through the O,P,Q,R,S,T, AAA framework as it provides the interviewer a strong understanding regarding important physiologic characteristics of the pain.
A complete medical and surgical history is important as well, especially current treatments and procedures the patient is undergoing as these often carry side effects which can cause pain syndromes.
ASCO, NCCN, and ESMO all recommend assessing the psychosocial impacts of the pain including how the pain is affecting their mental wellbeing, overall stress, daily functioning, social life, and diet/sleep, along with their understanding and beliefs regarding the pain [1,2,3]. This is based on the principles of “Total Pain” where clinicians recognize that patient pain is influenced not only by underlying pathology, but also by psychological, spiritual, emotional, and socioeconomic domains. Therefore, it is also important to inquire about social support networks, housing stability, access to medical care, and other key determinants of health that have been shown to exacerbate the severity and duration of pain. By acquiring a strong understanding of the context that the patient exists in, along with how their pain is presenting and affecting that context, you will be able to identify both medical and non-medical interventions that can support them.
2. Physical Exam, Further Investigations, and Red Flags
The physical exam and required further investigations will be dictated by the pain presentation and history and should be used to identify the relevant pathophysiology underlying the pain. It should be focused on identifying whether the pain is directly related to the tumour (such as spinal cord compression potentially due to metastasis), indirectly-related (such as a DVT due to a cancer-induced pro-coagulable state), related to iatrogenic causes (such as oral mucositis in someone on chemotherapy), or not related to their cancer or treatment at all (such as osteoarthritis). It should inform whether a patient is appropriate to be managed as an outpatient, requires further investigations, or needs hospital admission.
Reg flags clinicians should not miss are mainly based on tumour pain syndromes and other common medical emergencies but should always be based upon the examiner's clinical expertise and patient factors [4].
Before starting with pharmacologic interventions, the NCCN emphasizes the importance of incorporating non-pharmacologic interventions and multidisciplinary support into pain-management, where appropriate, as early as possible because it may lead to less reliance on analgesia [1]. This may include consulting surgical specialties, physiotherapy, promoting lifestyle changes that would improve pain, and helping patients strengthen their support networks.
Guidelines organize cancer-related pain into 3 severity levels: mild, moderate, and severe. Historically, the WHO 3-step model for pain management has been used as a starting point for selecting analgesic regimens for cancer-related pain [1].
There is controversy regarding the role of weak opioids in the 2nd step of the WHO Pain Relief Ladder. ASCO guidelines note that tramadol and codeine may be less desirable pain management options compared to other opioids because they are prodrugs which are highly susceptible to variable patient metabolism, leading to high risks of insufficient analgesia or toxic metabolite buildup [2]. ESMO guidelines note that studies have shown low doses of morphine may offer better analgesia than high doses of weak opioids, without any evidence of increased adverse events [3]. Therefore, ESMO states that for moderate pain relief it is appropriate to either start with weak opioids or going straight to low doses of strong opioids.
The standard non-opioid analgesics typically used for mild cancer-related pain are acetaminophen and NSAIDs. There is limited evidence on the effectiveness of acetaminophen on cancer-related pain, but many clinicians feel that due to the low risk profile the potential for benefit outweighs the risks [1]. The evidence for NSAIDs is similar, with no conclusive evidence supporting or refuting its use in mild to moderate cancer pain, either alone or combined with opioids [1]. Many clinicians try to avoid long-term NSAID use due to increased risk of GI bleeds, hypertension, and renal dysfunction. Overall, the evidence for non-opioid medications in cancer-related pain is neither strong nor weak and they are seen as a reasonable first-line option for mild-to-moderate pain management, but it is preferable to not use them chronically.
Opioid pain management is one of the most discussed topics in cancer pain guidelines. Due to the diverse opioid options and their many pharmacological subtleties, the use of clinical judgement and consideration of individual patient factors is paramount.
Weak opioids include codeine, tramadol, and dihydrocodeine. Strong opioid options include, but aren’t limited to, morphine, fentanyl, hydromorphone, oxycodone, methadone, and buprenorphine. There is increasing availability of combined opioid preparations as well, but their dosages are limited due to the nonopioid components. For example, combinations containing acetaminophen 500 mg would be limited to ≤8 tablets per day due to the risk of hepatotoxicity.
There is limited evidence suggesting any specific strong opioid is superior in efficacy. ESMO guidelines state that PO morphine, oxycodone, hydromorphone, and methadone are all reasonable first-line alternatives to consider. Traditionally PO morphine has been the recommended first-line opioid for moderate-to-severe cancer, but this appears to be a largely historical decision since it has been the most available and commonly prescribed option [1]. Clinically there may be preference for PO hydromorphone first-line because it has lower side effect risks in older adults and patients with renal dysfunction. Methadone is recommended to be started only by physicians with expertise and experience with it, since it is prone to causing undesired drug-drug interactions.
The ASCO, NCCN, and ESMO guidelines all recommend starting patients with chronic cancer pain on the lowest possible short-acting opioid dose, and it should be slowly titrated up until acceptable analgesia is achieved [1,2,3]. It should be the oral route of administration, unless other factors favoring another route of administration exist. Dose increases in the range of 25-100% are reasonable, depending on patient factors. Every opioid has their own validated titration ns which should be referenced, but guidelines emphasize the importance of switching to extended-release formulations once the patient has reached a stable dose of short-acting opioids.
In addition to the baseline dose, ESMO and NCCN recommend an oral rapid onset-short duration PRN “rescue” dose for breakthrough pain should also be prescribed. It can range from 10-20% of the total daily dose of opioids and given once an hour maximum. In cases of acute severe pain requiring urgent relief, it would be appropriate to initiate intravenous or subcutaneous opioids, and once stable switch the patient to long-acting formulations. If a patient is using multiple rescue doses per day after completing their opioid titration regimen, modification of the baseline opioid treatment should be considered. NCCN also clarifies that these rescue doses should be the primary analgesic regimen in the context of purely intermittent pain, instead of a regular dosing schedule.
For opioid naïve patients, PO morphine regimens commonly begin with a minimum 2.5-7.5 mg dose in a short-acting formulation, giving another dose every 4 hours that is titrated up 25-100%, and then once pain is controlled switching to a long-acting formulation. Stable dosing is generally achieved after 4-5 half-lives, approximately 24 hours, although longer titration times due to resistant pain are possible. The rescue dose would be 10-20% of the total daily dose, and the patient would be instructed to use it to relieve breakthrough pain up to every 1 hour as needed.
Typically, kidney impairment necessitates adjustment of opioid dosing due to increasing levels of renally cleared toxic metabolites. This leads to smaller doses with wider dosing intervals, but ESMO and ASCO highlight that fentanyl and buprenorphine transdermal patches are safer options in significant renal impairment (CKD stage 4/5) than PO morphine due to lower risk of toxic metabolite accumulation [1,2]. NCCN and ASCO also highlight a potential role for methadone in renal impairment because it is hepatically metabolized and excreted [3]. In cases of oliguria, specialist referral is warranted.
Opioid misuse is a high-risk consequence of prescribing opioid analgesic regimens, and the NCCN recommends monitoring risk factors for misuse using validated screening tools such as the Opioid Risk Tool, at both initiation of care and at regular intervals [1]. They also recommend the consideration of random urine drug testing to assess if patients may be aberrantly using or diverting their medication. In typical clinics this would only be considered for patients with a history of opioid diversion or opioid use disorder.
While the guidelines do not explicitly recommend a monitoring strategy for opioid adverse effects, it is intuitive that patients should be educated on common adverse effects and what to do if they arise. It follows that providers should inquire about the occurrence of common adverse effects during all encounters and provide prophylactic management or treatment where appropriate.
ESMO and NCCN guidelines state that when a patient is on an optimally titrated opioid and pain is refractory, or there are concerns with adverse effects, logistics/cost, or the route of administration, opioid rotation/switching should be offered to patients [1,2]. Opioid rotation/switching is when a patient is transitioned from one opioid to another, and although there are no explicit RCTs investigating the efficacy, it is commonly used in clinical practice. There is no evidence of a superior switching protocol, so the process is to be performed by a clinician balancing dose conversion ratios between opioids, incomplete cross tolerance between opioids, the underlying clinical situation, and patient factors. An in-depth discussion of the guidelines for opioid conversion are outside of the scope of this article; interested parties should refer to the 2025 MASCC-ASCO-AAHPM-HPNA-NICSO guidelines and consensus opioid conversion ratios [3].
If opioids are no longer indicated in a patient, such as after adequate response to cancer treatment, decreasing background pain, or patient preferences, they should be tapered off. Similar to opioid switching, ESMO states there is little evidence regarding opioid-tapering strategies in the oncologic population, so it is primarily determined by clinical experience and patient factors [1]. As a general principle, ASCO states that it is reasonable to aim for dose reductions in the 5-20% per month range for patients on stronger opioids for longer periods, while those on lower doses for shorter periods may be able to be reduced more rapidly [2].
It is important to note that certain subtypes of pain respond better to interventions other than non-opioid or opioid analgesics. These alternative interventions are considered adjuvant therapies when delivered in addition to non-opioid or opioid analgesics, but they may also be the primary therapy if given without other analgesics. While a comprehensive list of adjuvant analgesic options and their indications is outside the scope of this article, some common ones discussed by ESCO and ASCO guidelines include:
Overall, guidelines are limited regarding the use of cannabis or cannabinoids in the management of cancer pain. The ASCO guidelines state there is insufficient evidence to recommend medical cannabis for the first-line management of chronic pain in cancer survivors, but it is worthy of consideration as an adjuvant analgesic or in the management of refractory pain conditions [1]. There is also insufficient evidence to recommend one particular preparation of cannabis over another.
ESMO guidelines discuss the results of studies investigating nabiximols (an extract of cannabis sativa) against placebos [2]. They report that for advanced cancer patients with pain not fully alleviated by opioid therapy, the additive effect of nabiximols to the on-going opioid treatment remains unclear and more research is necessary before making a recommendation.
MASCC guidelines outright recommend against the use of cannabinoids for cancer pain due to poor efficacy, side effects, and the availability of other evidence-based therapeutic options with a more favorable benefit-to-risk ratio. They also note that there is some evidence that cannabis decreases the response of patients to checkpoint inhibitors and suggest against using cannabinoids for any indication in patients on checkpoint-inhibitor therapy.
Another set of MASCC guidelines also state that there is insufficient data to make a guideline recommendation about cannabis use for management of depression, anxiety, or insomnia in cancer patients, although they may be considered for refractory insomnia.
In addition to pharmacological approaches, cancer pain can also be managed with various other approaches which will be briefly discussed below. Although the discussion here is brief, these may be very beneficial to some patients when used appropriately
Question 1: Today is your first day in the pain clinic, and you meet a patient who describes severe arm pain in response to being touched on their arm and a crampy aching pain diffusely throughout their abdomen. How would you classify their pain?
a. Neuroplastic Pain
b. Visceral Nociceptive Pain
c. Nociplastic Pain
d. Visceral Nociceptive plus Nociplastic Pain
e. Visceral Nociceptive plus Neuroplastic Pain
Question 2: Mr. Owch is a 73-year-old male being treated with palliative chemotherapy for metastatic lung cancer. Unfortunately, the cancer has proven somewhat resistant to treatment. He is presenting to the pain clinic run by your local cancer agency today. He describes a new onset sharp stabbing pain in his upper back. When you percuss along his spine it localizes to the T4 vertebrae and he noticeably recoils away from your hand. What cancer pain syndrome best describes Mr. Owch’s pain?
a. Bone metastases
b. Plexopathy
c. Superior Vena Cava Obstruction
d. Trauma
Question 3: As per the WHO Pain Ladder, which of the following would be appropriate analgesic choices for management of mild nociceptive pain localized to the hallux?
a. Oral Tramadol
b. Oral Codeine
c. Oral Acetaminophen
d. Oral NSAIDs
e. Oral Morphine
Question 4: What is a very commonly used first-line opioid for management of cancer pain?
a. Oral Tramadol
b. Oral Codeine
c. Oral Fentanyl
d. Oral Hydromorphone
Question 5: Which of the following INCORRECTLY pairs an Analgesic with a known potential adverse effect of that Analgesic.
a. NSAIDS and Gastropathy
b. Acetaminophen and Hepatotoxicity
c. NSAIDS and Renal Failure
d. Opioids and Constipation
e. Opioids and Vision Loss
Question 6: Which of the following is NOT a known side effect of opioid use.
a. Urinary Frequency
b. Constipation
c. Sedation
d. Nausea and Vomiting
e. Confusion
Question 7: Of the following, which is a properly paired medication and adjuvant treatment?
a. Gabapentin and Somatic Pain
b. Venlafaxine and Intracranial Pressure
c. Salbutamol and Somatic Pain
d. Gabapentin and Neuropathic Pain
Question 8: You are discussing a patient’s current analgesic medications. This patient has known cirrhosis in addition to metastatic GI cancer. The patient’s pain has been difficult to control as they consistently report having “6 - 7 / 10 pain constantly” and you have been considering increasing his Tylenol 3 dosage to assist with pain relief. They are currently taking 60% of the maximum daily amount. Thankfully the pharmacist was there because she gently reminded you that switching to another opioid may be a reasonable approach in this patient because:
a. This patient has risk factors increasing the risk of complications for increasing Tylenol 3 closer to the maximum daily dose
b. Tylenol 3 does not contain any opioid and you had chosen the wrong analgesic from the start.
c. Codeine, the opioid component of Tylenol 3, is a very strong opioid and this patient has likely developed tolerance
d. Codeine is hepatically cleared and this conflicts with the patient’s known cirrhosis
1. d. Visceral Nociceptive plus Nociplastic Pain
Explanation: Patients commonly present with more than 1 type of pain classification. In this case, the crampy/aching abdominal pain is most likely due to pain from internal structures and therefore is visceral nociceptive pain. The disproportionate pain response to being touched on their arm is allodynia, and is a characteristic feature of nociplastic pain.
2. a. Bone metastases
Explanation: Bone metastases to the spine are one of the most common causes of pain in cancer patients. When a patient with known metastatic disease presents with palpable and focal pain localized to the vertebrae, vertebral metastases must be ruled out.
3. c. Oral Acetaminophen and d. Oral NSAIDs
Explanation: The first step of the WHO Pain Ladder explains that non-opioid analgesics are indicated for mild pain, which includes both acetaminophen or NSAIDs.
4. d. Oral Hydromorphone
Explanation: Oral hydromorphone is a commonly used first-line opioid analgesic in managing cancer pain, often preferrable to PO morphine due to lower risks of side effects in older adults and patients with renal impairment.
5. e. Opioids and Vision Loss
Explanation: Opioids are not associated with vision loss.
6. a. Urinary Frequency
Explanation: A side effect of opioid use is urinary retention, not urinary frequency.
7. d. Gabapentin and Neuropathic Pain
Explanation: Gabapentin is one of the medications recommended as adjuvant or first-line treatment for neuropathic pain in cancer patients.
8. a. This patient has risk factors increasing the risk of complications for increasing Tylenol 3 closer to the maximum daily dose
Explanation: Tylenol 3 is a combined opioid formulation composed of 300mg of acetaminophen and 30mg of codeine. It is important to remember with combined formulations that the non-opioid component is often the limiting factor for up-titrating doses due to the risk for liver damage. This is especially relevant in this case because cirrhosis makes a person more susceptible to acetaminophen toxicity, so it would be reasonable to switch to another opioid. It should also be noted that ESMO guidelines state there is no significant evidence to support or refute the use of paracetamol alone or in combination with opioids for moderate pain, making it even more reasonable to switch to a different opioid formulation.
Use your mouse to click through the slides and answer each question in the text box provided.
Note: This case can be completed on an iPad. To do this download the (free) Articulate Mobile Player for the iPad by clicking here.
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[3] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[4] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[5] Paice J, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34. doi: 10.1200/JCO.2016.68.5206
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[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[3] Paice J, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34. doi: 10.1200/JCO.2016.68.5206
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Verspyck E, Attal N. Diagnosing nociplastic pain in cancer survivors: a major step forward. Br J Anaesth. 2023;130(5). doi: 10.1016/j.bja.2023.02.006
[3] Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain. 2024;37(2):107-118. doi: 10.3344/kjp.23326
[4] Portenoy R, Ahmed E. Cancer Pain Syndromes. Hematol Oncol Clin North Am. 2018;32(3):371-386. doi: 10.1016/j.hoc.2018.01.002
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[3] Paice J, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34. doi: 10.1200/JCO.2016.68.5206
[4] Portenoy R, Ahmed E. Cancer Pain Syndromes. Hematol Oncol Clin North Am. 2018;32(3):371-386. doi: 10.1016/j.hoc.2018.01.002
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[1] Nekar AA, Hendrix JM, Cascella M. WHO Analgesic Ladder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [cited 2026 Feb 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554500/
[2] Paice J, Bohlke K, Barton D, Craig D, El-Jawahri A, Dawn L, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41:914-930. doi: 10.1200/JCO.22.02198
[3] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[1] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[1] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[3] Paice J, Bohlke K, Barton D, Craig D, El-Jawahri A, Dawn L, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41:914-930. doi: 10.1200/JCO.22.02198
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[3] Paice J, Bohlke K, Barton D, Craig D, El-Jawahri A, Dawn L, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41:914-930. doi: 10.1200/JCO.22.02198
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[3] Paice J, Bohlke K, Barton D, Craig D, El-Jawahri A, Dawn L, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41:914-930. doi: 10.1200/JCO.22.02198
[1] Swarm RA, Youngwerth JM, Agne JL, Anitescu M, Are M, Buga S, et al. Adult cancer pain, version 2.2025, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2025;23(7). doi: 10.6004/jnccn.2025.0032
[2] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[3] Davis, M.P., Davies, A., McPherson, M.L. et al. Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline. Support Care Cancer. 2025;33(243). doi: 10.1007/s00520-025-09286-z
[1] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
[2] Paice J, Bohlke K, Barton D, Craig D, El-Jawahri A, Dawn L, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41:914-930. doi: 10.1200/JCO.22.02198
[1] Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. Ann Oncol. 2018;29. doi: 10.1093/annonc/mdy152
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[3] To J, Davis M, Sbrana, A. Alderman B, Hui D, Mukhopadhyay S, et al. MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events. Support Care Cancer. 2023;31(202). doi: 10.1007/s00520-023-07662-1
[4] De Feo G, Case AA, Crawford GB, Hui D, To J, Sbrana A, et al. Multinational Association of Supportive Care in Cancer (MASCC) guidelines: cannabis for psychological symptoms including insomnia, anxiety, and depression. Support Care Cancer. 2023;31(176). doi: 10.1007/s00520-023-07628-3
