Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part I)

The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group guidelines on pharmacological management of cancer pain in adults provides a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub drafts addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website, and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that analgesics for cancer pain management should follow the World Health Organization three-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of first choice for moderate-to-severe cancer pain.