The WHO guidelines: the new and the old.

Area of Science:

• Oncology
• Pain Management
• Public Health

Background:

• The World Health Organisation (WHO) first published cancer pain guidelines in 1986.
• These guidelines have been globally adopted and utilized for decades.
• An updated version of the WHO cancer pain guidelines was released in 2018.

Purpose of the Study:

• To compare the original 1986 WHO cancer pain guidelines with the updated 2018 guidance.
• To evaluate the continued relevance and application of the WHO analgesic ladder in contemporary clinical practice.
• To identify key advancements and changes in cancer pain management strategies.

Main Methods:

• Comparative analysis of the 1986 and 2018 WHO cancer pain guidelines.
• Literature review focusing on evidence-based recommendations for cancer pain management.
• Critical appraisal of the WHO analgesic ladder's efficacy and limitations.

Main Results:

• The 2018 guidelines are more evidence-based, incorporating radiotherapeutic management recommendations.
• Enhanced focus on safe opioid prescribing, opioid stewardship, and early integration of pain management expertise.
• Lack of evidence for certain widely used therapies, particularly adjuvants, persists.
• The limitations of the original WHO analgesic ladder are highlighted, with evidence supporting the omission of 'step 2' as safe and cost-effective.

Conclusions:

• The updated WHO guidelines provide more detailed, clinically relevant recommendations, emphasizing opioid prescribing safety.
• The original WHO analgesic ladder is no longer endorsed as a rigid protocol for cancer pain management.
• Contemporary cancer pain management requires a more nuanced and evidence-based approach.