Opioid use in advanced malignant disease: why do different centers use vastly different doses? A plea for...

This paper reviews several recent publications concerning the use of opioids to control cancer pain and highlights the wide variation in mean daily dose. Present methods of reporting do not provide an explanation for these widely different doses used. It is essential that we understand the circumstances in which high doses are required, as higher doses are associated with greater toxicity and higher cost. Several factors that may influence the dose of opioid required are discussed. It is suggested that reporting of cancer pain, patient population, pharmacological and nonpharmacological interventions, and toxicity be standardized to allow for rational guidelines to be established for opioid use in pain due to advanced cancer.