Cancer Pain Management Clinical Practice Guidelines (2019)

World Health Organization

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 28, 2019

Guidelines for treating cancer pain in adolescents and adults were published in 2018 by the World Health Organization.[1]

Managing Cancer Pain

At initiation of pain management in adults (including the elderly) and adolescents with cancer pain, use NSAIDs, paracetamol, and opioids, either alone or in combination depending on clinical assessment and pain severity, in order to achieve rapid, effective, and safe pain control.

Any opioid may be considered for maintenance of pain relief, depending on clinical assessment and pain severity, in order to sustain effective and safe pain control in adults (including the elderly) and adolescents with cancer pain.

Treat breakthrough pain with a rescue medicine, such as the opioid morphine in its immediate-release formulation.

Use regularly dosed immediate-release oral morphine, or regularly dosed slow-release morphine, to maintain effective and safe pain relief. Use immediate-release oral morphine as rescue medicine with either formulation.

The subcutaneous route is preferred over intramuscular injection when oral or transdermal routes are not possible.

Adjuvant Cancer Pain Medications

Use adjuvant steroids to achieve pain control when indicated in adults (including the elderly) and adolescents with pain related to cancer.

Managing Bone Metastasis Pain

Use a bisphosphonate to prevent and treat bone pain in adults (including the elderly) and adolescents with bone metastases.

Use a single-dose fractionated radiotherapy when radiotherapy is indicated and available in adults (including the elderly) and adolescents with pain related to bone metastases.

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