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Cancer pain management with opioids: Prevention and management of side effects

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 cancer pain because of their safety, multiple routes of administration, ease of titration, reliability, and effectiveness for all types of pain (ie, somatic, visceral, neuropathic). (See "Assessment of cancer pain", section on 'Inferred pathophysiology (types of cancer pain)'.)

Opioids can produce dose-limiting side effects, the most common of which are constipation and mental clouding. There is marked interindividual variability in the sensitivity to adverse effects from opioids, which may be due to genetic differences, age, comorbidity, or interactions with other drugs.

Side effect management is a key element of opioid therapy for cancer pain. Effective treatment of side effects increases the likelihood of a favorable outcome. Side effects are a major contributor to the phenomenon of undertreatment of cancer pain. (See "Cancer pain management: General principles and risk management for patients receiving opioids", section on 'The problem of undertreatment'.)

In general, there are three approaches to treating adverse effects from opioids: symptomatic management, dose reduction, and changing to a different opioid or route of administration. Although symptomatic management strategies are based upon anecdotal experience or represent an extrapolation of approaches directed against similar symptoms that are caused by other mechanisms, they are widely accepted. (See "Cancer pain management with opioids: Optimizing analgesia", section on 'Practical considerations in opioid use'.)

This topic review will cover the prevention and management of specific adverse events in patients receiving opioid therapy for cancer pain. Assessment of cancer pain, an overview of specific cancer pain syndromes, the clinical use of opioid analgesics and non-opioid analgesics (including adjuvant analgesics), and non-pharmacologic methods of cancer pain management are covered elsewhere. (See appropriate topic reviews).


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Literature review current through: Jul 2017. | This topic last updated: Mar 30, 2017.
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