Table 2.

Summary of ESMO clinical practice guidelines.¹⁸ eGFR, estimated glomerular filtration rate; TD, transdermal.

Condition	Recommendation	Level of recommendation
Mild pain	WHO ladder Paracetamol—no evidence to support or refute NSAID—no evidence to support or refute	II, B I, C I, C
Moderate pain	Weak opioids in combination with non-opioids Low-dose strong opioids is alternative	III, C II, C
Severe pain	Oral morphine first line Fentanyl/buprenorphine safest in eGFR <30 Subcutaneous route considered if failed p.o. or TD I.V. infusion only considered when s.c. contraindicated For rapid pain control use i.v. opioid	I, A III, B III, B III, B III, B
Breakthrough pain	Immediate-release opioids	I, A
Bone pain	External beam radiotherapy (8 Gy single dose) Denosumab	I, A III, A
Neuropathic pain	First line: gabapentinoid, tricyclic or duloxetine Interventional treatments have inconclusive evidence	I, A II, C
Interventions	Cordotomy should be available in refractory cases Coeliac plexus block indicated in pancreatic cancer	V, C II, B