Challenges in prescribing opioids for cancer pain: an evaluation of adherence to the world health organization analgesic ladder in a public hospital

Keywords

cancer pain - pain management - opioid analgesics

Introduction: In solid and hematological neoplasms, at any stage of the disease, pain is a substantial public health problem worldwide. Its prevalence is 64% in patients with metastatic, advanced or terminal disease and 59% in patients undergoing antineoplastic treatment. Managing this type of pain is a challenge for health professionals, and the World Health Organization's analgesic ladder is a useful tool for this purpose. Opioids are the mainstay of treatment for this type of issue. Therefore, opioid turnover should be seen as an essential activity for better optimization of analgesia and reduction of adverse effects resulting from their use.

Objective: Analyze the profile of opioid use for managing cancer pain in hospitalized patients in a highly complex oncology unit.

Methods: A cross-sectional study with retrospective data collection from July 2023 in the medical clinic of a public hospital qualified as an oncology unit. The study began after approval by the local Research Ethics Committee (CAAE: 78810624.4.0000.5243). The opioid prescriptions of advanced-stage cancer patients were identified manually and analyzed using electronic medical record data. The data was analyzed according to the World Health Organization's opioid switch criteria of the analgesic ladder and descriptive statistics were used to understand the usage profile.

Results: The most prescribed opioid was tramadol representing 53.12% of prescriptions, even though weak opioids are considered second-line for this management. Of the 45 inpatients during the month, 5 reached the maximum dose of tramadol, but only 4 did the turnover to morphine. These patients spent an average of 6 days using tramadol at the maximum dose, even though there are studies showing the reliability of using low doses of morphine to manage mild to moderate pain instead of weak opioids.

Conclusion: The dose of opioids is influenced by the intensity of pain, but should be adjusted to balance pain relief and adverse effects. Lower doses of the representatives of the third level of the ladder have advantages over high doses of the second rung, in some cases. Evaluating the prescription of opioids according to the World Health Organization's analgesic ladder is an important strategy to help avoid adverse reactions and prevent the undertreatment cancer pain in order to contribute to increasing the quality of life of cancer patients.

Corresponding author: Katherine Cervai Ribeiro (e-mail: [e-mail]).

 

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Artikel online veröffentlicht:
06. Mai 2025