Intended for healthcare professionals


Commentary: Controversies in SIGN guidance on pain control in patients with cancer

BMJ 2008; 337 doi: (Published 05 November 2008) Cite this as: BMJ 2008;337:a2234
  1. J R Ross, consultant in palliative medicine 1, honorary senior lecturer2,
  2. J Riley, consultant in palliative medicine3
  1. 1St Joseph’s Hospice, London E8 4SA
  2. 2Imperial College, London SW3 6LR
  3. 3Royal Marsden Hospital, London SW3 6JJ
  1. Correspondence to: J Ross J.Ross{at}

    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 …

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