Pain in palliative care
Assessing cancer and palliative pain by type and cause, starting and titrating oral morphine, breakthrough doses, opioid choice in renal and hepatic impairment, bone and neuropathic pain, opioid toxicity, and the trials that changed practice.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- About two-thirds of people with advanced cancer have pain, and most can get good relief with oral drugs given by the clock, by the mouth and for the individual (WHO).
- Assess before prescribing. Name the pain type (nociceptive somatic, visceral, neuropathic, mixed) and cause, and look for emergencies such as cord compression, fracture or bowel obstruction.
- Oral morphine remains the reference strong opioid. Start low, titrate quickly, and provide a breakthrough dose of about one-tenth to one-sixth of the daily dose.
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Sources
- Therapeutic Guidelines: Palliative Care (eTG complete), version 5AU/NZTherapeutic Guidelines Limited, 2024 (version 5, December 2024)
- Lovell MR et al. Update of the Australian Guideline for the Management of Cancer Pain in Adults. Asia Pac J Clin Oncol 2026;22(5):705-716AU/NZCancer Council Australia, 2026 (online November 2025)
- WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescentsWorld Health Organization, 2018
- Fallon M et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018;29(Suppl 4):iv166-iv191European Society for Medical Oncology, 2018 (current at November 2026)
- Paice JA et al. Use of opioids for adults with pain from cancer or cancer treatment: ASCO guideline. J Clin Oncol 2023;41:914-930American Society of Clinical Oncology, 2023 (online December 2022)
- Opioid Analgesic Stewardship in Acute Pain Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022
- Opioid calculator and opioid dose equivalence resourcesAU/NZFaculty of Pain Medicine, Australian and New Zealand College of Anaesthetists
- Hardy J et al. Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. J Clin Oncol 2012;30:3611-3617AU/NZJournal of Clinical Oncology, 2012
- Palliative Care ScheduleAU/NZPharmaceutical Benefits Scheme, Australian Government, accessed November 2026
- Last updated
- 14 November 2026
What changed
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