Cancer Pain Care Requires More Than an Opioid Prescription

An opioid prescription can begin cancer pain treatment, but it cannot answer every question that follows: Is the patient obtaining meaningful relief? Does a medication change require closer monitoring? Are complementary treatments available for the specific pain being treated?

These questions align with the scope of the cancer pain plenary in the American Society of Regional Anesthesia’s 25th Annual Pain Medicine Meeting program. Held November 5 through 7, 2026, in Tampa, Florida, the meeting included a November 6 session listing presentations on modern opioid management, immune modulators, neuromodulation, and complementary approaches. For pharmacists, that agenda provides a timely framework for examining how medication decisions fit into broader cancer pain care.¹

Preserve Access to Appropriate Opioid Therapy

The American Society of Clinical Oncology (ASCO) recommends offering opioids to adults with moderate to severe pain related to cancer or active cancer treatment unless contraindicated. Its guideline supports starting treatment as needed at the lowest dose that achieves acceptable analgesia and the patient’s goals, followed by early assessment and frequent titration.²

For pharmacy practice, this makes follow-up part of the treatment plan. A useful conversation asks what relief the patient actually experiences and whether adverse effects interfere with daily activities. A prescription refill alone does not establish that the regimen is working. These questions can help pharmacists identify concerns to discuss with the oncology team.

The distinction between cancer pain and other prescribing contexts also matters. The CDC’s 2022 opioid guideline explicitly excludes cancer-related pain treatment, palliative care, and end-of-life care. Its recommendations should therefore not be treated as cancer-specific prescribing rules.³

When a prescription raises a concern, clarifying its indication and the prescriber’s plan provides a more appropriate starting point than assuming that recommendations developed for another population apply. Pharmacists can document that context so subsequent medication reviews begin with the same understanding.

Treat Medication Changes as Clinical Transitions

Switching opioids or changing administration routes introduces another point at which pharmacists can contribute. The 2025 MASCC-ASCO-AAHPM-HPNA-NICSO opioid conversion guideline addresses assessment before conversion, conversion strategies, and reassessment afterward. Its purpose is to reduce both overdosing and underdosing during these transitions.⁴

The evidence also warrants care in how conversion tools are used. The guideline’s systematic review identified 208 eligible studies, while the consensus process accepted 58 statements. Experts showed variability in conversion ratios, particularly for methadone, and the authors characterized the trial evidence as modest.⁴

For pharmacists, the practical implication is to make the conversion plan explicit. The receiving team should understand which regimen is being replaced, what the new instructions mean, and who will evaluate the response. A calculation is one component of that handoff, and the follow-up plan makes the transition reviewable.

Patients also need an opportunity to explain the new instructions in their own words. This can reveal uncertainty that would be difficult to identify from the medication list alone, giving the team time to clarify the plan before the next dose.

Match Complementary Care to the Pain Condition

Complementary treatments require the same attention to indication. The Society for Integrative Oncology–ASCO guideline recommends acupuncture for aromatase inhibitor–related joint pain. Acupuncture, reflexology, or acupressure may be recommended for general cancer pain or musculoskeletal pain, whereas massage may be recommended for pain during palliative or hospice care.⁵

Those recommendations do not establish equal evidence for every intervention marketed to patients with cancer. The guideline describes evidence for other mind-body interventions or natural products as low or inconclusive. Pharmacists can use that distinction when patients ask whether a complementary option has support for their particular symptoms.⁵

In practice, the conversation can move beyond a general suggestion to try complementary care. Identifying the pain condition first gives the oncology team a clearer basis for discussing an appropriate referral and assessing whether the patient can access it.

Make the Next Assessment Clear

Across these decisions, pharmacists can help make cancer pain care easier to follow: clarify the treatment goal, document concerns requiring action, and establish who will reassess the patient. This approach translates the meeting’s broad cancer pain agenda into a practical question at each encounter: what does this patient need before the next treatment decision?

REFERENCES

1. Live stream program: 25th Annual Pain Medicine Meeting. ASRA Pain Medicine. November 5-7, 2026. Accessed November 11, 2026. https://asra.com/events-education/pain-medicine-meeting

2. Paice JA, Bohlke K, Barton D, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023;41(4):914-930. doi:10.1200/JCO.22.02198

3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(3);1-95. doi:10.15585/mmwr.rr7103a1

4. Davis MP, Davies A, McPherson ML, et al. Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline. Support Care Cancer. 2025;33(3):243. doi:10.1007/s00520-025-09286-z

5. Mao JJ, Ismaila N, Bao T, et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357