The 2010 edition of the NCCN Clinical Practice Guidelines for Adult Cancer Pain (hereinafter referred to as the Guidelines) has revised some of the entries while maintaining the basic principles of cancer pain treatment when compared with previous years’ guidelines. The main changes are as follows: i. Comprehensive pain management Comprehensive pain management includes comprehensive assessment and quantification of pain, psychological interventions, and patient education. The guidelines propose that when assessing patients for pain, it should first be clarified whether the pain is due to oncologic emergencies and classify cancer pain in 3 aspects: (i) whether the pain is related to the tumor and treatment; (ii) whether the pain is acute or chronic in nature; and (iii) according to the pathologic mechanism to facilitate subsequent oncologic treatment. It is also proposed that medical and treatment histories should be understood when assessing the pain level of patients to determine the expected survival and physical status. In addition, the 2010 edition of the guideline has increased the requirements for severe pain, emphasizing the need to assess pain level from point to point, and the need to pay attention to the influence of language and culture on pain assessment to ensure effective communication between doctors and patients and to accurately grasp the patient’s pain level. The new guidelines also have higher requirements for the route of administration. Oral administration remains the first choice for pain management, with continuous intravenous or subcutaneous pumping of pain medication when the patient requires a more rapid-acting pain reliever or when the patient is unable to tolerate the side effects of oral administration, cannot swallow, or has an oral absorption disorder. However, when patients cannot tolerate the side effects of peripheral administration, they can be treated by interventional means. Related interventional means include neurodesis, percutaneous vertebroplasty, neurostimulation therapy, radiofrequency ablation for bone metastases, etc., although they should be selected only after assessing the patient’s condition. Second, drug selection issues Specific guidance is given for complex pain management to avoid simplification of complex issues. It includes the selection of drug therapy, basic principles of opioid application, dose adjustment, side effect prevention and control, indications and timing of interventional therapy, etc. The opioid-based pain treatment is one of the core principles of the guidelines, and the new version of the guidelines further clarifies the concept of opioid tolerance and emphasizes the regularity of opioid drug use. The new version of the guideline quotes the definition of the U.S. FDA, changing the original “Patients not taking opioid” to “Opioid naive patients” and “Patients taking opioid” to “Patients taking opioid”. Patients taking opioid” was changed to “Opioid tolerance patients”, thus making the clinical definition of opioid tolerance clearer and suggesting that opioid-intolerant patients should prefer morphine for pain relief, and opioid-tolerant patients should evaluate the efficacy and side effects of opioids before choosing opioids at their discretion. This better reflects the characteristics of the guidelines and avoids unnecessary controversies. The new guidelines also emphasize the importance of regulating the use of opioid medications. It is clearly stated that extended-release fentanyl formulations should only be used in opioid-tolerant patients, except for acute severe pain where the dose of the underlying analgesic is insufficient; fentanyl is contraindicated in fever, local heat therapy, or the use of electric blankets; and the dose ratio is 1:1 when fentanyl is administered intravenously as a transdermal patch. The guidelines also state that codeine and morphine should be avoided in patients with renal failure; tramadol is a weak opioid with antidepressant effects and is recommended for mild to moderate pain. It is recommended for the treatment of mild to moderate pain and not recommended for severe pain; pethidine and propoxyphene are not recommended due to the central nervous system toxicity of their metabolites; pentazocine, nalbuphine, buprenorphine and diazoxide are mixed agonists and are not recommended for use. In addition, buprenorphine was removed from the nonrecommended opioids. The guidelines also recommend that one opioid be used to treat both the underlying pain and the eruptive pain as much as possible. Third, the use of NSAIDs drugs For the first step of pain medication – non-steroidal drugs (NSAIDs) related to the comparison of research, the use of this drug during chemotherapy is considered high risk, while opioids are relatively safer; when using NSAIDs, liver function must be measured regularly, when transaminases are 1.5 times higher than normal, stop using This class of drugs. The FDA is re-evaluating the maximum dose of acetaminophen in light of its hepatotoxicity, and doses should be carefully selected for clinical use. The new guidelines also state that gabapentin and pregabalin should be titrated slowly in elderly and frail individuals, and that the dose should be adjusted for renal insufficiency, which also requires a dose titration process. In addition, the causes of side effects during treatment should be analyzed comprehensively to prevent all complications from being attributed to the application of opioids. The new version of the guideline also clarifies the indications for methylnaltrexone, that is, methylnaltrexone can be used in patients with progressive tumors who have opioid therapy-related constipation and when conventional treatment is not effective, and advocates paying attention to the clinical diagnosis and treatment of intestinal obstruction, with new examples and basic principles of treatment of intestinal obstruction.