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Morphine and alternative opioids in cancer pain: the EAPC recommendations

Organiser: Hanks GW, de Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Roca i Casas J, Sawe J, Twycross RG, Ventafridda V

This paper is a result of the Expert Working Group on Opioids which first met in Sicily in 1992 and produced an earlier publication: Morphine in cancer pain: modes of administration. BMJ 1996; 312: 823-826. Because of the success of that publication and its widespread distribution the Expert Working Group met again and up-dated it and extended its recommendations to cover the use of alternatives to morphine.

An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.

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Morphine and alternative opioids in cancer pain: the EAPC recommendations
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