[12 basic rules in drug therapy of tumor pain]

Successful pharmacologic treatment of cancer pain is founded upon careful assessment and measurement of pain before and during therapy. Strong opioids should be used timely in accordance to the WHO 3-step analgesic ladder. The oral route should always be favored. Frequent opioid side effects include constipation, temporary nausea and vomiting and are to be treated adequately. Slow release morphine preparations are to be administered every 12 hours. Adjustment of dose follows pain intensity. Immediate release morphine for breakthrough pain should be provided routinely to patients maintained on a 12-hourly regimen of slow release morphine. The appropriate rescue dose will be 1/6 of the total daily morphine dosis. In case of changement of route of administration the relative potency ratio of oral morphine to parenteral morphine is about 3:1. The coadministration of nonopioids is essential for the relief of cancer pain in many cases. Adjuvant drugs may provide pain relief in specific types of pain (e.g. neuropathic pain).