In the clinical work of cancer pain management, there are often some misconceptions. These misconceptions may have an impact on the rational use of pain medications. Most of the misconceptions in cancer pain treatment focus on the misconceptions about opioids. Myth 1: It is safer to use non-opioid drugs In fact, for patients who need long-term pain medication for chronic cancer pain, it is safer to use opioid drugs, which have no toxic effects on liver, kidney and other organs for long-term use. However, there is a concomitant increase in the risk for long-term use of NSAIDs. Physicians should then be familiar with the restrictive doses of NSAIDs. According to clinical trials, the upper dose of NSAIDs is generally limited to 1.5-2.0 times the standard recommended dose. When the NSAID dose reaches the restrictive dose, if the pain is still not satisfactorily controlled, only the opioid dose should be increased. Opioid analgesics should be preferred for the treatment of moderate or severe cancer pain. In 2000, the WHO suggested that “although there are various pharmacological and non-pharmacological treatments for cancer pain, opioid analgesics are essential in the treatment of cancer pain among all pain management methods. For patients with moderate and severe cancer pain, opioid analgesics have an irreplaceable position. Therefore, the International Narcotics Control Board (INCB) emphasizes the need to ensure the availability of opioids in pain management.” Myth 2: Use painkillers only when pain is severe In fact, timely and on-time use of painkillers is safer and more effective, and requires the lowest strength and dose of painkillers. Cancer pain patients who do not receive effective pain relief treatment for a long time are prone to sympathetic nerve dysfunction related to neuropathic pain caused by pain, which manifests as abnormal pain with nociceptive hypersensitivity and other intractable pain. Myth 3: Analgesic treatment is sufficient for partial relief of pain In fact, the purpose of analgesic treatment is to relieve pain and improve the quality of life of patients. Pain-free sleep is the minimum requirement of pain relief treatment. In addition to this goal, ideal pain relief treatment should also aim at pain-free rest and pain-free activities to achieve the goal of improving patients’ quality of life in the real sense. Myth 4: When adverse reactions such as vomiting and sedation occur with opioids, opioids should be stopped immediately In fact, except for constipation side effects, most of the adverse reactions of opioids are temporary or tolerable. Adverse reactions to opioids, such as vomiting and sedation, generally occur only in the first few days of use, and the symptoms disappear on their own after a few days. Active preventive treatment of opioid adverse reactions can reduce or avoid the occurrence of adverse reactions. In fact, the WHO has listed dulcolax as a drug not recommended for cancer pain treatment. The pain-relieving effect of dulcolax is only 1/10 of that of morphine, and the metabolite desmethyl dulcolax has a long elimination half-life and has potential neurotoxic and nephrotoxic effects. In addition, because of the poor oral absorption rate of dulcolax, it is mostly administered by intramuscular injection. Intramuscular injection itself can produce pain and should not be used for chronic pain treatment such as cancer pain. Myth 6: Only patients with end-stage cancer can use the maximum tolerated dose of opioid painkillers. In fact, there are large individual differences in the dose of opioid painkillers, and a few patients need opioid doses for pain treatment. There is no capping effect of opioid analgesics, and if the condition worsens and pain increases, the effectiveness of pain management can be improved by increasing the dose of opioid medication. For any patient with severe pain, regardless of the clinical stage of the tumor and the expected survival time, a large tolerated dose of opioid analgesics can be used to achieve the desired pain relief as long as the pain treatment is needed. Myth 7: Long-term use of opioid painkillers will inevitably lead to addiction In fact, the risk of addiction (psychiatric dependence) for cancer pain patients treated with opioids for a long time, especially when administered orally or by transdermal patch on time, is extremely small. In the course of her long-term practice of treating patients with advanced cancer, Professor Sun Yan has encountered only 4 cases of psychiatric dependence in more than 40 years. On average, there is only one case every 10 years, and none of them has occurred since the WHO cancer pain relief was launched in 1990. The risk of psychiatric dependence with opioids reported by Porter abroad is less than 4 per 10,000 (4/11882 cases). All of these facts indicate that opioid addiction in cancer patients is very rare. The development of tolerance or physical dependence on opioids does not imply addiction, nor does it affect the safe continued use of opioids for pain management. Opioid controlled extended-release dosage forms or transdermal administration in a timely manner can avoid excessive peak blood levels, thereby reducing the risk of addiction. Myth 8: If opioids are widely used, they will definitely cause abuse. Actively implementing WHO’s three-step cancer pain treatment principles and carrying out publicity and education on the rational use of opioid painkillers will not only enable the majority of cancer pain patients to receive ideal pain treatment, but also avoid or reduce the risk of opioid abuse. Since the WHO issued the three-step cancer pain relief guidelines in 1992, the global medical consumption of morphine has been on the rise. 2.2 tons of morphine were consumed worldwide in the 1980s, and 22 tons of morphine were consumed worldwide in the 1990s. However, the significant increase in global opioid consumption has not been accompanied by an increase in the risk of opioid abuse. Myth 9: Once opioids are used, they may be needed for life In fact, opioid pain medication can be safely discontinued at any time after cancer pain is controlled by the disease and the pain subsides. When the daily dose of morphine is 30-60mg, sudden discontinuation of the drug will not cause any accident. For long-term high-dose users, sudden discontinuation may result in end-of-withdrawal syndrome. It is recommended that patients who have been using large amounts of morphine for a long period of time should gradually reduce the dose and stop. The dose should be reduced by 25%-50% within the first two days, and then by 25% every two days until the daily dose is reduced to 30-60 mg. Observe the patient’s pain and the presence of agitation symptoms such as diarrhea when reducing the dosage. If the pain score is >3-4 or if there are withdrawal symptoms, the dosage should be reduced slowly. Myth 10: Pain treatment with opioids means giving euthanasia Treatment with opioid painkillers is not euthanasia. On the contrary, using opioid painkillers according to the condition of cancer pain can not only effectively control pain, but also reduce the risk of death caused by severe pain, improve the quality of life and effectively prolong the survival of patients. Maefartane reported that a prospective pain survey of 6569 cancer patients in the Northwest of England with up to 8 years of follow-up in 1991-1992 found a mortality rate of 1.55 for patients with localized pain and widespread pain and 2.07 for patients with widespread pain. Deaths from non-disease causes (e.g., car accidents, suicide, homicide, etc.) were also higher (mortality rate of 5.21). The investigators concluded that widespread body pain complained by cancer patients was strongly associated with cancer deaths. According to this result, it is projected that widespread body pain lasting for one day may increase the risk of cancer death by at least 20%, so aggressive pain relief treatment is associated with reducing the risk of death due to pain and plays an indirect role in prolonging life. Myth 11: Lung cancer patients cannot use opioids In fact, patients with lung cancer pain can safely and effectively use opioid painkillers. The crux of people’s doubts about the use of opioid painkillers for lung cancer patients lies in the concern about the respiratory depressant effect of opioids. There is concern that patients with lung cancer and metastatic lung cancer may have a low tolerance for opioid pain medications due to poor lung function. Respiratory distress caused by lung disease is a peripheral lesion, i.e. caused by pulmonary lesions, while respiratory depression caused by opioids is a central effect of the drug, i.e. a side effect on central respiratory depression, which generally occurs only in the case of overdose, especially when the peak blood concentration value rises extremely rapidly, such as when large intravenous doses are used, or when the drug accumulates poisoning, such as when renal insufficiency. When opioids are used reasonably in cancer pain patients, adverse reactions of respiratory depression are rare. The main reasons for this are: firstly, pain is a natural antagonist of the adverse effects of opioid respiratory depression, and patients with severe pain rarely experience respiratory depression with opioid analgesics; secondly, patients with cancer pain will soon become tolerant to the side effects of respiratory depression with opioid drugs for a long time. In fact, opioids are essential for cancer pain treatment, and the diversity of their types, dosage forms and specifications is conducive to individualized clinical drug administration. Opioid analgesics are essential in the treatment of cancer pain. For patients with moderate and severe cancer pain, opioid analgesics have an irreplaceable position. Therefore, the International Narcotics Control Board has emphasized the need to ensure the availability of opioids for pain management”. Currently, the types and dosage forms of pain medications available for clinical use in most hospitals do not meet the needs of all patients, especially those with specific conditions. For example, there is a misconception that the availability of opioid-controlled, slow-acting formulations is sufficient. In fact, for most cancer patients, opioid-controlled and extended formulations are needed along with a back-up immediate release agent. The use of opioid immediate-release formulations facilitates rapid titration to the optimal dose for individualized dosing during the initial phase of pain management. During the course of pain management, a standby opioid immediate-release agent can help control sudden or explosive pain.