Comparison of guidelines for pain management in palliative patients

Due to increasing life expectancy and great number of palliative patients in the world guidelines for treating pain are necessary for better quality of life of those patients. We have compared Croatian national guidelines for pain management in adults, ESMO (European Society for Medical Oncology) guidelines, guidelines of American Society of Clinical Oncology Clinical Practice (ASCO) and WHO (World Health Organization) guidelines. We wanted to know if Croatian guidelines are following the good clinical practice of ESMO, ASCO and WHO guidelines. Comparing the guidelines we have determined that all guidelines are similar, there are slight differences in usage of cannabinoids as drugs in pain management. All guidelines emphasize active role of patient in pain management, all use the same classification of pain (mild, moderate and severe pain) based on visual analogue scale. All four mentioned guidelines have 3 steps of pain management and recommended drugs to be used; first step paracetamol and NSAID, second step mild opioids with combination of NSAID and paracetamol, and third step usage of strong opioids. ESMO and ASCO also indicate that usage of cannabinoids could reduce the usage of strong opioids, but it must that be investigated furthermore. Croatian guidelines are up to date according to ESMO, ASCO and WHO guidelines. The only difference is emphasizing the usage of cannabinoids which should be considered in future Croatian guidelines for pain treatment