Cancer pain management: newer perspectives on opioids and episodic pain

Cancer pain is significantly undertreated, but the current armamentarium of opioids and other analgesics are such that no cancer patient should be in pain. The guidelines for the treatment of cancer pain suggest that a long-acting, preferably oral, opioid be administered around the clock for persistent baseline pain, along with a short-acting oral opioid for episodes of breakthrough pain. Morphine is the gold standard for ATC opioid treatment, and OTFC is emerging as a potent agent for the management of breakthrough pain. The careful assessment and management of persistent cancer pain and breakthrough pain will help realize the goal of optimal pain management for all cancer patients.