Chronic cancer pain

Pain in patients with active malignancy, chronic course. Foundation: WHO analgesic ladder; in moderate-to-severe pain, opioids are used with no upper dose ceiling when properly titrated.

ICD-10 G89.31 drug

Drugs used for this condition

AMorphineFirst line · Natural opium alkaloidsFirst-line for moderate-to-severe cancer pain per WHO Cancer Pain Ladder and ESMO 2018. In cancer patients, opioids are used without upper dose ceiling when properly titrated and tolerated. Opioid-naive starting dose: 5–10 mg orally every 4 hours (immediate release) or 1–2 mg IV. After stabilization, switch to extended-release twice daily. Duration is not capped.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit