Most patients with cancer experience pain. The ambitious task of the Scottish Intercollegiate Guidelines Network (SIGN) when producing its guidelines on pain control in patients with cancer was to achieve a single set of evidence based recommendations for professionals delivering generic palliative care and for those in specialist palliative care units, across both the acute and community settings. Management of complex pain requires good assessment, good communication, attention to spirituality and psychological issues, and detailed knowledge of analgesics. As such, this comprehensive, well researched guidance from SIGN will be an important resource.1

The availability and delivery of different opioids for breakthrough pain has greatly increased recently, particularly for new rapid onset opioids. Misuse of opioids poses serious risks to patients, clinicians, and society as a whole. Drug exposure in itself is not sufficient to cause a substance related disorder, but a fast acting opioid …