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Two recent studies in the Journal of Clinical Oncology add to our understanding of cancer pain treatments.
The World Health Organization's traditional three-step analgesic ladder consists of nonopioids, weak opioids, and strong opioids for treating patients with mild, mild-to-moderate, and moderate-to-severe cancer pain, respectively. But some experts argue that skipping weak opioids (step 2) and moving directly to low doses of so-called strong opioids (e.g., morphine) is reasonable when nonopioid analgesics are inadequate.
In an open-label randomized trial from Italy, researchers assigned 240 opioid-naive cancer patients with moderate pain to receive either step-2 analgesics (codeine or tramadol, usually combined with acetaminophen and titra…