Strategies for Pain Management: Cleveland Clinic Foundation Guidelines for Opioid Dosing for Cancer Pain

Abstract Pain remains the most common distressing symptom in advanced cancer. Opioids are the most effective drugs for pain currently available. Analgesia depends largely on appropriate administration. Cancer clinicians should be proficient in opioid pharmacotherapy. Although knowledge of general opioid dosing principles is helpful, in practice, complex clinical scenarios often arise, requiring more sophisticated and precise dosing maneuvers for which there is very little evidence-based literature. Familiarity with specific strategies indicated for common clinical problems provides a more focused approach and increases the likelihood of therapeutic success. This article enumerates cancer pain scenarios compiled from our palliative medicine practice and the opioid dosing strategies used by the palliative medicine department within the Cleveland Clinic Foundation.