How to use opioid analgesics effectively and safely. Individual choice of the opioid in patients with cancer pain from the perspective of 2022

Research and clinical experience in recent years have brought huge progress in the treatment of chronic pain with the use of opioid analgesics. It was shown that this treatment can be effective and safe, although many aspects of therapy still need to be investigated, and the rules for choosing an opioid in various clinical situations need to be further elucidated. The aim of the study was to summarize the knowledge on the use of opioids in the treatment of pain in cancer patients and the features differentiating individual drugs in this pharmacological class. The paper presents the results of research on the treatment of cancer pain with the use of opioids, including publications of the Cochrane database. Based on the literature, the essential differences between opioids resulting from their pharmacokinetic properties, mechanisms of action, genetic variability, and their profile of adverse effects, which may be an indication for choosing or discontinuing a given drug, are discussed. The work was supplemented with tables summarizing studies published in the Cochrane database, and it presents a comparison of oral and transdermal opioids and recommendations regarding the choice of opioids in people with hepatic and renal insufficiency.