The World Health Organization (WHO) has published new guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. The last set of WHO guidelines on cancer pain management were issued in 1996.
The guidelines recommend patients should be started on a type and strength of analgesic appropriate to the type and severity of pain. Mild analgesics should not be given alone for initiation of treatment of moderate or severe pain. Any opioid may be considered for maintenance of pain relief, depending on clinical assessment and pain severity.
The authors make a strong recommendation that adjuvant steroids may be given to achieve pain control when indicated. “When treating cancer pain or complications due at least in part to oedema surrounding a tumour, steroids with the least mineralocorticoid effect are preferable,” they state.
The guidelines recommend that in adults and adolescents with bone metastases, a bisphosphonate should be used to prevent and treat bone pain. In those with pain related to bone metastases, single-dose fractionated radiotherapy should be used when radiotherapy is indicated and available.
They also recommend that psychosocial care should be considered when devising patient care plans.