Pharmacotherapy of pain in cancer patients
– recommendations of the Polish Association for the Study
of Pain, Polish Society of Palliative Medicine, Polish Society
of Oncology, Polish Society of Family Medicine, and Polish
Society of Anaesthesiology and Intensive Therapy
Authors: Wordliczek Jerzy , Kotlińska-Lemieszek Aleksandra , Leppert Wojciech , Woroń Jarosław , Dobrogowski Jan , Krajnik Małgorzata , Przeklasa-Muszyńska Anna , Jassem Jacek , Drobnik Jarosław , Wrzosek Anna , Janecki Marcin , Pyszkowska Jadwiga , Kocot-Kępska Magdalena , Zajączkowska Renata , Filipczak-Bryniarska Iwona , Boczar Krystyna , Jakowicka-Wordliczek Joanna , Malec-Milewska Małgorzata , Kübler Andrzej , Suchorzewski Marek , Mordarski Sylwester 
Published: January 2018

for the pharmacotherapy of pain in cancer patients were developed by a group of 21
experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of
Oncology, Polish Society of Family Medicine, and Polish Society of Anaesthesiology and Intensive Therapy.
During a series of meetings, the experts carried out an overview of the available literature on the treatment
of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized
studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane
Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”,
“analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer
patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain
in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory
drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists,
NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to
reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected
to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia
were discussed and recommendations for the management of opioid-induced hyperalgesia were presented.
Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral
pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs
used in the pharmacotherapy of pain in cancer patients as well as the principles for the pharmacotherapy of
pain in cancer patients with organ dysfunctions (circulatory failure, chronic obstructive pulmonary disease, renal or hepatic failure) were also discussed. In addition, principles for the management of crisis situations
as well as cases of opioid overdose or opioid-induced respiratory depression were presented. In the final part
of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are
addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily
practice. It is the hope of the experts who took part in the development of these recommendations that the
recommendations would become helpful in everyday medical practice and thus contribute to the improvement
in the quality of care and the efficacy of pain treatment in this group of patients.