Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network

Pål Klepstad*, Stein Kaasa, Nathan Cherny, Geoffrey Hanks, Franco De Conno, K. Torvik, R. Likar, J. Menten, J. Kakas, L. Pederson, E. Kalso, P. Poulain, L. Radbruch, K. Mystakidou, V. Sigurdardotii, T. O'Brien, B. Thill, B. Zylics, J. A. Ferraz Goncalves, L. Ionescu-CälinestiJ. M. Nunes, C. J. Fürst, F. Porchet, K. Done, G. Forche, J. P. Zoidl, H. Retschitzegger, M. Werni-kourik, B. Stapel, C. Stabel, A. Verhoeve, P. Cornil, M. Faignaert, T. van Iersel, K. Sterckx, R. Veekhoven, K. Claassen, C. Biek, J. Indirjian, S. Michael, B. Pitsillides, R. Christou, N. Koupi, M. Mørk, A. Bonde, B. Enig, T. Saarto, J. Leno, B. Veronique, R. Duclos, L. Hacpille, G. Laval, M. H.H. Salagne, P. Vinan, M. Cremer, F. Nauck, G. Hanekop, L. Latasch, W. Diemer, M. Kloke, C. Bausewein, C. Müller-Busch, J. Dale, D. Alison, M. Fallon, L. Forman, C. Sinnott, A. Wilcock, C. Regnard, M. Nugent, K. Forbes, C. Higgs, E. Tsiouri, A. Kritikou, E. Argiraki, T. Christos, G. Evgenia, E. Kosmidou, M. Tsitoura, S. Björnsson, N. Fredriksdottir, G. Thorsdottir, H. Helgadottir, E. Hjörleifsdottir, L. O'Siorain, S. Kingston, J. Flemming, R. McQuillan, M. Kearney, S. Donelly, T. McCormack, Y. Zinger, R. Gassner, M. Bercovitch, E. Arcuri, Augusto Caraceni, Sebastiano Mercadante, Juan Manuel Nunez Olarte, Carla Ripamonti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The Research Network of the European Association for Palliative Care (EAPC) performed a survey of 3030 cancer patients from 143 palliative care centres in 21 European countries. The survey addressed pain intensity and the use of non-opioid analgesics, adjuvant analgesics and opioids. Patients were treated with analgesics corresponding to the WHO pain ladder step I (n=855), step II (n=509) and step III (n=1589). The investigators assessed 32% of the patients as having moderate or severe pain. In general there were small differences between pain intensities across different countries. Cancer primary sites and the presence of metastasis had only minor influences on pain intensity. The most frequently used non-opioid analgesics were NSAIDs (26%) and paracetamol (23%). Adjuvant analgesics or co-analgesics used by >1% of the patients were corticosteroids (39%), tricylic antidepressants (11%), gabapentin (5%), bisphosphonates (4%), clonazepam (2%), carbamazepine (4%) and phenytoin (2%). The use of non-opioid analgesics and co-analgesics varied widely between countries. Opioids administered for mild to moderate pain were codeine (8%), tramadol (8%), dextropropoxyphene (5%) and dihydrocodeine (2%). Morphine was the most frequently used opioid for moderate to severe pain (oral normal release morphine: 21%; oral sustained-release morphine: 19%; iv or sc morphine: 10%). Other opioids for moderate to severe pain were transdermal fentanyl (14%), oxycodone (4%), methadone (2%), diamorphine (2%) and hydromorphone (1%). We observed large variations in the use of opioids across countries. Finally, we observed that only a minority of the patients who used morphine needed very high dose.

Original languageEnglish
Pages (from-to)477-484
Number of pages8
JournalPalliative Medicine
Issue number6
Publication statusPublished - 1 Sep 2005


  • Analgesics
  • Cancer
  • Opioid
  • Pain
  • Palliative care
  • Survey


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