Practice points• Adequate pain management starts with an appropriate syndromic diagnosis based on a detailed clinical history, comprehensive physical examination and correct interpretation of additional medical tests.• Appropriate syndromic classification of pain is based on its clinical characteristics, as well as on a meticulous assessment of the intensity of pain by applying standard scales. The patient's psychosocial situation must be taken into account when attempting to optimize management and predict the response to treatment.• As with all types of chronic pain, assessment of patients with cancer pain should take into account the individual profile of the patient (age, comorbidities, functionality, previous exposure to drugs such as opioids and polypharmacy) and the type, intensity and potential clinical course of the pain. Only thus will it be possible to decide on the best approach, based on aspects such as efficacy, safety, tolerability and cost. Multimodal strategies are the most successful.• Multimodal approaches include interventional, psychological, rehabilitative and integrative therapies.• Various formulations of fentanyl have been reported for the treatment of breakthrough pain, as follows: transmucosal, intranasal, sublingual, buccal tablets and gingival. However, these formulations are not available in Latin America.• In Latin America, the WHO guidelines have proven critical for justifying to local governments the key role of opioids such as morphine and the need for an adequate supply. Nevertheless, availability of opioids in the region remains poor.• Treatment of severe pain should be with a strong opioid, in most cases with oral formulations. Other routes (intravenous, subcutaneous, spinal (epidural and intrathecal) may only be necessary in refractory cases.• Extended-release opioids (morphine, oxycodone and hydromorphone) can be supplemented with immediate-release formulations as needed. Assessment of comorbidities is essential when deciding on the best option.For reprint orders, please contact: reprints@futuremedicine.com

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