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Cancer pain management with opioids: Optimizing analgesia

Russell K Portenoy, MD
Zankhana Mehta, MD
Ebtesam Ahmed, PharmD, MS
Section Editor
Janet Abrahm, MD
Deputy Editor
Diane MF Savarese, MD


Opioids are widely used for treatment of pain in patients with cancer because of their safety, multiple routes of administration, ease of titration, reliability, and effectiveness for all types of pain (ie, somatic, visceral, neuropathic). Although neuropathic pain may be more difficult to treat, a favorable response to opioid-based analgesia is often possible. (See "Assessment of cancer pain", section on 'Inferred pathophysiology (types of cancer pain)'.)

Opioids are also potentially abusable drugs. The public health consequences of opioid abuse drive the imperative that all physicians assume responsibility for risk management when these drugs are prescribed for legitimate medical purposes. These issues are discussed elsewhere. (See "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'Risk assessment and management for patients receiving opioids'.)

This topic review will cover the use of opioids for cancer-related pain, with an emphasis on optimizing analgesia and minimizing side effects. Assessment of cancer pain, a review of specific cancer pain syndromes, general principles of cancer pain management, an overview of risk management in patients treated with opioids, prevention and management of opioid side effects, the clinical use of non-opioid analgesics (including NSAIDs and adjuvant analgesics), non-pharmacologic methods of cancer pain management, management of acute pain (eg, from a new injury or surgical procedure) in the patient chronically using opioids, and issues surrounding pain management in the last weeks of life are covered elsewhere.

(See "Assessment of cancer pain".)

(See "Overview of cancer pain syndromes".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 15, 2017.
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