1. Guidelines


a. WHO Analgesic Ladder
b. NCCN Guideline

2. Evidence


a. Lancet 2007: change of morphine dose (absolute or percentage change) NOT associated with mortality
b. Pain Symptom Manage 2010: use of morphine for cancer pain

3. Assessment


a. Numerical Rating Scale (NRS)
b. Brief Pain Inventory
c. Edmonton Symptoms Assessment Scale (ESAS)
d. McGill Quality of Life Questionnaire

4. Equi-analgesic dosing




5. Opioid Efficacy


a. Codeine

Cochrane Review: codeine alone or in combination with paracetamol has limited evidence to evaluate the treatment for cancer pain

b. Hydrocodone

Cochrane Review: NO significant difference between hydrocodone/paracetamol and codeine/paracetamol in pain control

c. Fentanyl

FDA approved for use in mod. to severe pain in opioid tolerant patient
- transdermal patch for chronic pain
- buccal for breakthrough pain (Fentora)
- Cochrane Review: less constipation compared with morphine

d. Methadone

EQUIMETH2 trial (J Pain Symptom Manage 2016): stop-and-go method does not improve pain control as compared with 3-day gradual reduction.

e. Oxycodone

Cochrane Review: Long acting oxycodone has similar efficiacy compared with long acting mrophine in cancer pain
- Clin J Pain 2010: in patient with pancreatic cancer, oxycodone did not provide better pain control compared with morphine

6. Comparative Efficacy



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