Cancer pain

What's new

The Multinational Association of Supportive Care in Cancer (MASCC) and the American Society of Clinical Oncology (ASCO) have released a new guideline on opioid conversion in adults with cancer. Opioids should be initiated as immediate-release and administered on an as-needed (PRN) basis to establish an effective dose, with early assessment and frequent titration. Opioid rotation should be offered to patients with pain that is refractory to dose titration of a given opioid, poorly managed side effects, logistical or cost concerns, or difficulties with the route of administration or absorption. Genetic testing, such as for CYP2D6 polymorphisms, is not recommended to guide opioid dosing due to insufficient evidence. In patients with renal impairment, rotation to methadone is suggested due to its primary fecal excretion. Opioids that are primarily eliminated in the urine, such as fentanyl, oxycodone, and hydromorphone, should be carefully titrated and closely monitored for accumulation of the parent drug or active metabolites. Morphine, meperidine, codeine, and tramadol should be avoided in this population. .