Miaskowski, C., Cleary, J., Burney, R., Coyne, P., Foster, R., Grossman, S., . . . Zahrbock, C. (2005). Guideline for the management of cancer pain in adults and children. APS Clinical Practice Guidelines Series. Glenview, IL: American Pain Society.

PROCESS OF DEVELOPMENT: An interdisciplinary panel of experts in cancer pain management prepared these guidelines. When unavailable, recommendations were not made or were made on the recommendation of experts in that area.

• Make patient and family caregiver education about pain management a part of the treatment plan, and encourage patient and family caregivers to participate actively in pain management. 
• Collaborate with patients and family caregivers, taking costs and availability of treatment options into account when selecting pain management strategies. (Panel consensus)

• Perform a comprehensive pain assessment of all patients with cancer at each outpatient visit or hospital admission and use each patient’s self-report as the foundation for the assessment. 
• Include in the comprehensive pain assessment a detailed history to determine the presence of persistent and breakthrough pain and its effects on function; a psychosocial assessment; a physical examination; and a diagnostic evaluation of signs and symptoms associated with common cancer pain presentations and syndromes. 

• Develop a systematic approach to cancer pain management and teach patients and family caregivers how to use effective strategies to achieve optimal pain control.
• Begin a bowel regimen to prevent constipation when the patient is started on an opioid analgesic. 
• Administer a long-acting opioid on an around-the-clock basis, along with an immediate-release opioid to be used on an as-needed basis, for breakthrough pain once the patient’s pain intensity and dose are stabilized. 
• Do not use meperidine in the management of chronic cancer pain. 
• Adjust opioid doses for each patient to achieve pain relief with an acceptable level of side effects. 
• Avoid intramuscular administration because it is painful and absorption is unreliable.
• Use optimally titrated doses of opioids and maximal safe and tolerable doses of coanalgesics through other routes of administration before considering spinal analgesics. (Panel consensus)
• Monitor for and prophylactically treat opioid-induced side effects.
• Clarify myths and misconceptions about pain management, and reassure patients and family caregivers that cancer pain can be relieved and that addiction and tolerance are not problems associated with effective cancer pain management.
• Use cognitive and behavioral strategies as part of a multimodal approach to cancer pain management, not as a replacement for analgesic medications.

• Offer patients who decline to have procedural sedation nonpharmacologic alternatives to decrease procedure-related pain. 

• Implement a formal process to evaluate and improve the quality of cancer pain management across all stages of the disease process and across all practice settings. 
• Evaluate the quality of cancer pain management at points of transition in the provision of services (e.g., from the hospital to the home) to ensure that optimal pain management is achieved and maintained.