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Curr Oncol. 2019 Jun;26(3):e410-e413. doi: 10.3747/co.26.4517. Epub 2019 Jun 1.

Framing of the opioid problem in cancer pain management in Canada.

Author information

Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.
Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.


Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain. The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.


Canadian pain guideline (2017); Chronic pain; European pain guideline (2017); cancer pain; mental health; opioids; pain; substance use disorders

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

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