WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018
(2018; 144 pages)


Cancers are among the leading causes of morbidity and mortality worldwide, responsible for 18.1 million new cases and 9.6 million deaths in 2018, significantly increasing the burden on patients, families, communities and the health system. Pain is experienced by 55% of patients undergoing anti-cancer treatment and by 66% of patients who have advanced, metastatic, or terminal disease.

The goal of cancer pain management is to relieve pain to a level that allows for an acceptable quality of life. The World Health Organization (WHO) Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents are intended to provide evidence-based guidance to health-care providers on appropriate approaches to initiating and managing cancer pain in adolescents and adults, including older persons. The guidelines can act as the basis for national guidelines and for the inclusion of cancer pain management and care in primary health care programmes, using a person-centred and integrated approach.

The aims of these guidelines are: To provide management guidance to health-care providers (i.e. the end-users of these guidelines: physicians, nurses, pharmacists and caregivers) on the adequate relief of pain associated with cancer or its treatment in adults and adolescents.

To assist policy-makers, programme managers and public health personnel to create and facilitate appropriately balanced policies on opioids and prescribing regulations for effective and safe cancer pain management.

The scope of these guidelines includes medical and radiotherapeutic management of cancer pain. Anaesthetic, psychological, social, spiritual, physiotherapeutic and surgical modes of cancer pain management are integral to comprehensive cancer pain management, and are discussed in this document, but are outside the scope of these guidelines.

The clinical guidelines and recommendations in this document are organized into three focal areas:

■ Analgesia of cancer pain: This addresses the choice of analgesic medicine when initiating pain relief and the choice of opioid for maintenance of pain relief, including optimization of rescue medication, route of administration, and opioid rotation and cessation.

■ Adjuvant medicines for cancer pain: This includes the use of steroids, antidepressants and anticonvulsants as adjuvant medicines.

■ Management of pain related to bone metastases: This incorporates the use of bisphosphonates and radiotherapy to manage bone metastases. Following publication of the guidelines, a series of subsidiary products will be developed that will address service delivery aspects of implementation, including World Health Organization (WHO) guidance on cancer pain assessment.

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