Standards for the management of cancer‐related pain across Europe—A position paper from the EFIC Task Force on Cancer Pain
EFIC · 2019 · Europe
Source and licence
- Authors
- Michael I Bennett, Elon Eisenberg, Sam H Ahmedzai et al.
- Title
- Standards for the management of cancer‐related pain across Europe—A position paper from the EFIC Task Force on Cancer Pain
- Journal
- European Journal of Pain (London, England), 2019
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC7027571
Licence statement of the original publication
This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
INTRODUCTION
- 1A. Strong recommendation, high‐quality evidence
- 1B. Strong recommendation, moderate‐quality evidence
- 1C. Strong recommendation, low‐quality evidence
- 2A. Weak recommendation, high‐quality evidence
- 2B. Weak recommendation, moderate‐quality evidence
- 2C. Weak recommendation, low‐quality evidence
Standard 10. Each EFIC chapter should have national evidence or consensus‐based guidelines in place for cancer‐related pain [GRADE 1C]
- We recommend that each country will develop a mechanism, by either professional organizations or through regulatory authorities, to monitor and assess the implementation and usage of national guidelines and European standards.
Abstract
Background and objective: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta‐analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self‐management and late or inadequate access to strong opioid analgesia in those with advanced disease.
Methods: The European Pain Federation (EFIC) established a Task Force in 2017 which convened a European group of experts, drawn from a diverse range of relevant clinical disciplines, to prepare a position paper on appropriate standards for the management of cancer‐related pain. The expert panel reviewed the available literature and made recommendations using the GRADE system to combine quality of evidence with strength of recommendation. The panel took into account the desirable and undesirable effects of the management recommendation, including the cost and inconvenience of each when deciding the recommendation.
Results and conclusions: The 10 standards presented are aimed to improve cancer pain management and reduce variation in practice across Europe. The Task Force believes that adoption of these standards by all 37 countries will promote the quality of care of patients with cancer‐related pain and reduce unnecessary suffering.
Significance: Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.
Contents of the original publication
The section headings of the original.
- INTRODUCTION
- STANDARDS
- Standard 1. Patients with a history of cancer should be routinely screened for pain at every engagement with a healthcare professional. [GRADE 1B]
- Standard 2. Patients identified with cancer‐related pain should receive a pain assessment when seen by a healthcare professional, which at a minimum classifies the cause of pain based on proposed ICD‐11 taxonomy and establishes the intensity and impact on quality of life of any pain that they report. [GRADE 1B]
- Standard 3. A multimodal pain management plan should be agreed with the patient who explains the causes of their pain and its likely prognosis, the need for further investigations, the multimodal treatment options, and includes the patient’s preferences and goals for treatment. [GRADE 1C]
- Standard 4. Patients should receive tailored multimodal treatment which reduces the pain and its impact on daily living and that may include a combination of medicines, nonpharmacological treatments, oncological interventions, physical rehabilitation and psychosocial or spiritual support. [GRADE 1A]
- Standard 5. Support and advice for self‐management should be provided [GRADE 1A]
- Standard 6. The pain management plan should be reviewed regularly to assess outcomes and plan longer‐term care [GRADE 1B]
- Standard 7. Patients should be referred for more specialist advice and treatment if pain is not improving within a short time or if they are experiencing intolerable side effects of analgesia [GRADE 1C]
- Standard 8. Healthcare professionals who treat patients with cancer should receive ongoing education and training in order to undertake basic pain assessment, initiate basic management, and learn about correctly referring for more specialist support [GRADE 1C]
- Standard 9. Regular review of service outcomes for all patients with cancer pain should be in place [GRADE 1C]
- Standard 10. Each EFIC chapter should have national evidence or consensus‐based guidelines in place for cancer‐related pain [GRADE 1C]
- SUMMARY
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