The lesson from cancer pain

The success of the WHO guidelines for the treatment of cancer pain indicates that cancer pain was previously undertreated. At the heart of these guidelines lies the three-step analgesic ladder, the last two steps of which consist of prescribing opioids. Today, the use of opioids in cancer patients is generally accepted, but there are still some concerns over the risks of addiction and adverse reactions, and opioids are sometimes withheld from patients who would otherwise benefit from them. However, it has been shown that such concerns are misplaced: the risks of severe adverse reactions and addiction are low when opioids are used correctly in patients with chronic pain. The use of opioids to treat benign pain is even less widely accepted in many countries, despite recommendations that they should be prescribed. It is emphasized that the use of opioids is a valid option for treating benign pain, and they should not be withheld from patients who need them. Opioids are always indicated when other therapeutic options, including NSAIDs, have failed or are contraindicated. When opioids are prescribed, procedures should be followed to provide the patient with maximum benefit and minimum risk.