Roughly 80% of patients with advanced-stage cancer have moderate to severe pain. Pain occurs in 20% to 50% of patients with cancer. The appropriate use of adjuvant pharmacological and nonpharmacological interventions is needed to optimize pain management.
The results of an open-label randomized trial of low-dose morphine versus weak opioids to treat moderate cancer pain suggested that it is acceptable to bypass weak opioids and go directly to strong opioids (step 3 agents) for patients with moderate cancer pain, as patients randomly assigned to the low-dose morphine group had more frequent and greater reduction in pain intensity with similarly good tolerability and earlier effect.įamiliarity with opioid pharmacokinetics, equianalgesic dosing, and adverse effects is necessary for their safe and effective use. Step 3 opioids include morphine, hydromorphone, fentanyl, levorphanol, methadone, oxymorphone, and oxycodone.