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Modern insights in the nature and treatment of cancer pain: focus on opioids
  1. Augusto Caraceni
  1. Correspondence to Augusto Caraceni, European Palliative Care Research Center, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, via Venezian 1-20133 Milano Italy, and Norwegian University of Science and Technology (NTNU), Trondheim, Norway; augusto.caraceni{at}

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Cancer pain management was identified as a priority in the overall programme of cancer control by WHO in 1982, considering that the majority of patients have solid tumours and at least 50% die of the disease, and this proportion is even higher in developing countries. While curative and disease-modifying therapies may not be available or accessible due to lack of resources, access to effective pain relief using simple pharmacological methods should be provided to all patients with cancer pain given the efficacy and low cost of oral morphine, which is the prototype opioid analgesic and the mainstay of an effective pharmacological strategy. The strategy summarised in the WHO analgesic ladder includes non-steroidal anti-inflammatory drugs, paracetamol, opioids and adjuvants, as well as other interventions in selected cases. The emphasis on pharmacological therapies and the relevance of opioid use were clearly highlighted in the WHO recommendations. The WHO campaign and the WHO analgesic ladder, published in 1986,12 had a major impact by disseminating knowledge and raising awareness worldwide when, in many countries, oral morphine was not available or accessible, there was professional and societal opposition to the use of opioids in pain clinics, and morphine and opioids in general were considered to be dangerous and inappropriate medications.

Unnecessary suffering depends on lack of drugs and lack of compliance with available guidelines

Over the past 30 years there has been a rich growth in interest, service provision and professional expertise in symptom management of patients with advanced incurable diseases, including cancer, thanks to the dissemination in Europe and the rest of the World of the palliative care movement. Palliative care, which is becoming an increasingly recognised field of medicine, has emphasised symptom control with a special focus on the use of opioids for managing cancer pain and facilitating fruitful dialogue with other specialties …

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