Pain Management / Palliative Care

GlobalRPh Pain, Analgesia & Serious-Illness Care Resources

Pain Management, Palliative Care & Opioid Stewardship Resource Center

Opioid conversion and MME tools, methadone and fentanyl resources, multimodal and nonopioid pain management, neuropathic pain and fibromyalgia, regional and interventional analgesia, cancer pain, serious-illness palliative care, medication safety, symptom support, and current GlobalRPh pain articles.

Pain calculators Opioid stewardship Palliative care Internal Medicine Sections

Clinical background

Pain intensity matters, but function, mechanism, goals and treatment burden matter too

Pain may be acute or chronic, nociceptive, neuropathic, nociplastic, cancer-related or mixed. The same numeric pain score can represent very different biology and different effects on sleep, mobility, mood, cognition, work and social function. Modern pain management therefore combines diagnosis, functional assessment, realistic goals, nonpharmacologic treatment, nonopioid medications, interventional options and opioids when their expected benefits justify the risks.

Palliative care overlaps with pain management but is broader. It addresses pain and other symptoms, communication, caregiver needs, psychological and spiritual distress, treatment burden and alignment of care with patient goals in serious illness. It can be provided alongside disease-directed treatment and should not be equated automatically with hospice or the final days of life.

Mechanism Nociceptive, neuropathic and nociplastic pain often respond differently to treatment.

Function Mobility, sleep, participation and quality of life can be more informative than pain score alone.

Risk Respiratory disease, age, renal/hepatic function and sedating co-medications change medication safety.

Goals Chronic pain, active cancer treatment and end-of-life care can require different benefit-risk frameworks.

Acute & perioperative pain
Chronic noncancer pain
Neuropathic / nociplastic pain
Opioid stewardship & rotation
Cancer-related pain
Palliative symptom management
Regional / interventional analgesia
Shared decision-making & serious illness

Illustration Of Spinal And Peripheral Pain Pathways

Foundational GlobalRPh pain tool

Advanced Opioid Conversion Calculator

The GlobalRPh Advanced converter can combine up to three source opioids, convert to a selected target opioid, apply an incomplete-cross-tolerance reduction, and handle specialized fentanyl and methadone workflows. It remains one of the site’s most useful pain-pharmacy tools while we update the conversion evidence and safety framework.

Open the Advanced Opioid Converter

Serious-illness care

Palliative Care: Too Late or Too Early?

GlobalRPh’s newer palliative-care review moves the section beyond an opioid-only model by emphasizing earlier symptom management, communication, caregiver support, treatment-goal alignment and interdisciplinary care for serious illness.

Open the Palliative Care Review

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Core GlobalRPh pain calculators

Opioid conversion, MME, methadone, fentanyl, NSAIDs and regional analgesia

The existing portal links only four calculators even though GlobalRPh’s Pain Management calculator archive is larger. The rebuild surfaces the additional tools while making their clinical purpose more explicit.

Opioid exposure & rotation

Nonopioid / procedural tools

Risk / cancer-specific support

Historical opioid-conversion tools are still available for continuity

These remain accessible for historical comparison, but the principal GlobalRPh opioid-rotation destination on this portal is the current Advanced Opioid Conversion Calculator above.

Opioid stewardship, MME & rotation

MME risk assessment and opioid rotation are not the same calculation

This distinction is now explicit because using an MME table as if it were a direct dose-switching table can create unsafe conversions. Equianalgesic ratios are estimates, and incomplete cross-tolerance, residual drug, route, opioid-specific pharmacology and the reason for switching must be considered.

MME / MED: exposure & risk context

MME can help standardize opioid exposure for population-level comparisons and selected risk discussions. It is not a validated method for directly selecting a new opioid dose during rotation.

Opioid rotation: individualized conversion

Rotation requires an estimated equianalgesic relationship followed by a clinically appropriate safety reduction, patient-specific reassessment and careful titration. Methadone and fentanyl require additional caution.

GlobalRPh opioid tools

Current opioid safety

GlobalRPh current reading

Important scope distinction: the CDC 2022 Clinical Practice Guideline applies to adults receiving outpatient care for acute, subacute or chronic pain and explicitly does not apply to cancer-related pain treatment, palliative care, end-of-life care or sickle-cell-related pain. Cancer and palliative opioid management should therefore use the disease-specific guidance linked later on this page.

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Chronic pain & function-first care

Move beyond treating a number on a pain scale

Chronic-pain care is more useful when it tracks meaningful function—sleep, mobility, activity, work, self-care and participation—alongside symptoms and adverse effects. Multimodal treatment can combine physical rehabilitation, behavioral strategies, nonopioid medications and selected interventional therapies.

Define the pain mechanism Inflammatory/nociceptive, neuropathic, nociplastic and mixed pain require different treatment priorities.

Define functional goals Walking, sleep, work, exercise, self-care or participation can provide measurable treatment targets.

Use multimodal therapy Exercise/rehabilitation, behavioral treatment, sleep, medications and procedures can be combined.

Reassess benefit vs burden Continue treatments that improve meaningful outcomes without disproportionate adverse effects.

Current GlobalRPh chronic-pain reviews

Nonopioid pharmacotherapy

Evidence-based chronic-pain guidance

“Nonopioid” does not automatically mean “low risk.” NSAIDs, gabapentinoids, antidepressants and muscle relaxants have organ-function, sedation, bleeding, fall and drug-interaction considerations that should be matched to the individual patient.

Neuropathic pain, fibromyalgia & nociplastic pain

Mechanism-based treatment without assuming every “nerve pain” syndrome is the same

GlobalRPh medication resources

Current / emerging pain reading

Gabapentin and pregabalin can contribute to sedation and respiratory depression, particularly in patients with respiratory risk factors or when combined with opioids or other CNS depressants. Renal dose adjustment is also important for both agents.

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Acute, perioperative & regional analgesia

Epidurals, local anesthetics, nerve blocks, PCA and multimodal perioperative care

GlobalRPh procedural resources

Regional anesthesia / nerve blocks

Safety considerations

Neuraxial and regional techniques require protocol-specific local-anesthetic dosing, anticoagulation review, neurologic monitoring and preparedness for local-anesthetic systemic toxicity.

Cancer pain & oncology supportive care

Use cancer-specific opioid guidance rather than importing chronic-noncancer thresholds

Cancer pain may arise from tumor burden, treatment, surgery, neuropathy, bone disease or survivorship. Opioids remain appropriate for selected moderate-to-severe cancer-related pain, but conversion, adverse-effect prevention, nonmedical opioid use and long-term survivorship require structured assessment.

GlobalRPh cancer-pain tools

Current cancer-pain guidance

Oncology / palliative crossover

A 2025 MASCC-ASCO-AAHPM-HPNA-NICSO guideline now provides a dedicated evidence-based framework for opioid conversion in adults with cancer, including pre-conversion assessment, conversion strategy and post-conversion reassessment. We plan to use this as a major reference when rebuilding the GlobalRPh Advanced Opioid Converter.

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Palliative care & serious illness

Palliative care is broader than pain control and earlier than hospice

Palliative care can accompany active treatment for cancer, heart failure, COPD, kidney disease, neurologic disease and other serious illness. Pain is one domain alongside dyspnea, nausea, constipation, fatigue, delirium, anxiety, depression, communication, caregiving and treatment priorities.

GlobalRPh serious-illness resources

Symptom-support cross-links

Prognostic tools and frailty scores can support conversations, but they should not be used as automatic gatekeepers for ICU care, disease-directed treatment or hospice. Their role is to improve understanding, communication and patient-centered decision-making.

Illustration Representing Multisite Pain And Serious-Illness Symptom Burden

Current palliative-care guidance

Organ-disease crossover

Medication simplification / burden

Pain pharmacotherapy

GlobalRPh analgesic, adjuvant and procedural drug tables

All major drug tables from the current Pain portal are retained but reorganized by clinical function.

Opioids

Nonopioid / adjuvant analgesia

Procedural / supportive medications

The current GlobalRPh opioid table includes discontinued or rarely used agents and older PCA/dosing references. We are retaining the page for continuity while we systematically verify marketed products, current labeling, organ-function dosing and opioid-specific safety.

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GlobalRPh Pain / Palliative article library

Current and established pain-management reading

The existing portal surfaces only six articles. The replacement brings forward newer GlobalRPh material on function-first chronic pain, nonopioid therapy, opioid stewardship, palliative care, neuromodulation, regional anesthesia and serious-illness decision-making.

2026

Medication Burden and Deprescribing: A Whole-List Review Approach Opioids • Benzodiazepines • Gabapentinoids • Sedation • Deprescribing Frailty Before the ICU Serious illness • Goals of care • ICU escalation • Frailty Defining Analgesia & Implementing Safe Opioid Therapy Protocols Opioid stewardship • Naloxone • Multimodal pain • Monitoring Neuromodulation for Depression & Chronic Pain Spinal cord stimulation • TMS • VNS • Refractory pain Reimagining Code Status in the 80+ Population Shared decision-making • Goals of care • Serious illness Pain Management Beyond Scores Function-first care • Chronic pain • Rehabilitation • PROMs Non-Narcotic Pain Medication: Evidence-Based Chronic Pain Strategies NSAIDs • Neuropathic pain • Topicals • Nonopioid therapy Fibromyalgia and Lupus Together Nociplastic pain • Disease activity • Composite scores From Nursing Home to Hospital and Back Serious illness • Transitions • Frailty • Goals of care Psychedelics in Anesthesia and Pain: From Curiosity to Clinical Research Emerging research • Anesthesia • Pain • Not routine therapy Breaking Through Pain Barriers: Long-Acting Nerve Blocks Regional anesthesia • Nerve blocks • Multimodal analgesia The Opioid-Free OR Multimodal anesthesia • Perioperative opioids • Evidence review

2025 & established content

The Role of Palliative Care in Internal Medicine Palliative care • Serious illness • Early integration Ultrasound-Guided Regional Anesthesia Regional anesthesia • Nerve blocks • Perioperative pain The Opioid Crisis in Family Practice: Safe Prescribing vs Abandoning Patients Chronic pain • Opioid stewardship • Patient-centered care Exploring New Drugs for Neuropathic Pain Neuropathic pain • Medication therapy • Video Osteoarthritis Pain & Dietary Change Osteoarthritis • Diet • Chronic pain Chronic Pain Management & Virtual Interfacing Telehealth • Chronic pain • Digital care Wound Care: Treatment Options for Pain Procedural pain • Wound care • Analgesia Ketamine Infusion in Chronic Pain Ketamine • Refractory pain • Monitored therapy Cannabis Medicinal Products for Fibromyalgia Pain Fibromyalgia • Cannabis • Evidence review Pain Management: Its Various Aspects – Historical GlobalRPh Overview Foundational pain overview • Update in progress

Pain Article Archive Pain Calculators Chronic Pain Articles

GlobalRPh Pain video library

Current dedicated video and future pain/palliative topics

The current GlobalRPh master video library has one dedicated Pain Management video. The rebuild retains it and identifies high-value topics for future expansion rather than relabeling unrelated videos as pain content.

Existing Pain Management video

Exploring New Drugs for Neuropathic Pain: Latest Treatment Options

Neuropathic-pain pharmacology and emerging treatment options.

Open the GlobalRPh Video Library

High-value videos to develop

MME vs opioid rotation: why the numbers are not interchangeable
Incomplete cross-tolerance and safe opioid switching
Methadone conversion and QT / accumulation concerns
Fentanyl patch conversion and residual drug release
Function-first chronic pain assessment
Nonopioid and multimodal chronic-pain therapy
Cancer pain and the 2025 opioid-conversion guideline
Palliative care vs hospice: when to involve each

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Planned GlobalRPh updates

Areas we’re continuing to improve in the Pain Management / Palliative Care library

GlobalRPh has maintained opioid-conversion, NSAID, PCA and pain-drug resources for many years. Opioid labeling, cancer conversion guidance, palliative medicine, gabapentinoid safety, multimodal pain care and interventional analgesia have continued to evolve. We plan to preserve the strongest tools while modernizing the evidence and safety framework behind them.

Pages we plan to refresh

Advanced Opioid Conversion Calculator: this is our highest-priority Pain Management update. We plan to reconcile the older 1990s–2015 equianalgesic references with the 2025 MASCC-ASCO-AAHPM-HPNA-NICSO cancer-opioid-conversion guideline and updated AAHPM equianalgesic resources, while preserving explicit incomplete-cross-tolerance controls and clear warnings that conversions are estimates.
MME / MED Calculator: we plan to separate MME risk/exposure assessment from opioid rotation much more explicitly, update current conversion factors where appropriate, and reinforce that MME values are not direct instructions for choosing a replacement opioid dose.
Methadone Dosing Calculator: the current tool relies heavily on 1998–2015 references. We plan to update nonlinear conversion, bidirectionality limitations, accumulation, QT/interaction risks, opioid-tolerance context and specialist consultation thresholds.
Fentanyl Patch Converter: the current standalone calculator is based largely on 2006–2008 labeling/literature. We plan to update transdermal selection, opioid-tolerance requirements, conversion uncertainty, heat/fever risk, residual fentanyl release after patch removal and current labeling.
Fentanyl Conversions: we plan to reconcile IV/transdermal conversion assumptions with current labeling and palliative-care conversion evidence and clearly separate research/equianalgesic estimates from bedside titration.
NSAID Selection Tool: the current calculator still relies substantially on 2007–2012 cardiovascular/rheumatology references. We plan to update GI, renal, cardiovascular, heart-failure, anticoagulation, pregnancy and older-adult risk; topical NSAIDs; current COX-2 evidence; and duration/dose principles.
Opioids / Combination Products: the current table contains discontinued and obsolete agents, older maximum-dose language and historical PCA material. We plan to rebuild it around currently marketed products, current opioid labeling, acetaminophen combination limits, naloxone/reversal, organ-function considerations and clinically relevant interactions.
Partial opioid agonists / buprenorphine: we plan to expand the older table into a current buprenorphine-focused analgesia and OUD crossover resource, clearly separating formulations, indications, transitions and prescribing contexts.
PCA: we plan to update opioid concentrations, basal-infusion risk, monitoring, opioid tolerance, respiratory-risk stratification, naloxone availability and smart-pump/institutional safeguards.
Epidural / local anesthetic resources: we plan to update common mixtures, concentrations, neuraxial/regional safety, anticoagulation verification, local-anesthetic systemic toxicity and institutional protocol dependence.
Pregabalin vs gabapentin: we plan to update evidence by neuropathic-pain syndrome, renal dosing, misuse potential, weight/edema effects, older-adult considerations and FDA respiratory-depression warnings when combined with opioids/CNS depressants.
Fibromyalgia: we plan to modernize pharmacologic and nonpharmacologic treatment, nociplastic-pain framing, sleep/exercise, psychological therapy, medication burden and avoidance of unsupported opioid escalation.
Chronic pain assessment: we plan to build a function-first framework using pain interference, activity, sleep and patient-reported outcomes rather than relying only on a 0–10 intensity score.
Cancer pain: we plan to add a dedicated GlobalRPh cancer-pain page that integrates ASCO opioid guidance, the 2025 joint conversion guideline, breakthrough pain, bowel prophylaxis, neuropathic components, survivorship and specialist palliative-care involvement.
Palliative care: we plan to expand beyond opioid conversion into multidimensional symptom assessment, dyspnea, nausea, constipation, delirium, anxiety, caregiver burden, communication, goals of care and serious-illness medication simplification.
Prognostication / goals-of-care tools: we plan to evaluate which validated tools meaningfully support communication without turning prognostic estimates or frailty scores into automatic treatment-denial rules.
Opioid safety / reversal: we plan to make current FDA opioid-label changes, overdose-reversal-agent discussions, abrupt-taper avoidance and high-risk sedating combinations much more visible throughout the Pain library.

Opioid Rotation 2.0 Evidence-updated conversion with reason-for-switch, cross-tolerance and reassessment prompts.

MME risk dashboard Keep exposure/risk estimation separate from equianalgesic dose rotation.

Function-first pain tracker Track sleep, activity, mobility, interference and treatment benefit rather than intensity alone.

Palliative-needs screen Identify symptom burden, caregiver stress, recurrent utilization and communication needs.

Renal opioid safety tool Flag opioid/metabolite accumulation and dosing-review needs across CKD and dialysis.

CNS co-medication risk review Surface opioid + benzodiazepine + gabapentinoid + muscle-relaxant respiratory/sedation burden.

Our goal is to preserve GlobalRPh’s practical pain-pharmacy calculators while making the distinction between chronic noncancer pain, cancer pain and palliative/end-of-life care much clearer—and while ensuring the safest current conversion and medication information is easier to find.

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Current external pain & palliative guidance

Use the guideline that matches the clinical population

The portal intentionally separates chronic-noncancer opioid guidance from cancer/palliative care. These are not interchangeable populations, and dose or monitoring recommendations should be applied within the scope for which they were developed.

CDC Clinical Practice Guideline for Prescribing Opioids for Pain – 2022 For outpatient adults with acute, subacute or chronic pain. It excludes cancer-related pain treatment, palliative care, end-of-life care and sickle-cell-related pain. Open CDC guidance

VA/DoD Use of Opioids in Chronic Pain – 2022 Evidence-based chronic-pain opioid guidance emphasizing patient safety and risk-benefit assessment. Open VA/DoD chronic-pain guidance

VA/DoD Low Back Pain – 2022 Evidence-based diagnosis and management guidance for one of the most common chronic-pain syndromes. Open low-back-pain guidance

ASCO: Opioids for Adults With Pain From Cancer or Cancer Treatment – 2023 Cancer-specific guidance on opioid use, administration and prevention/management of opioid adverse effects. Open ASCO cancer-pain guidance

MASCC-ASCO-AAHPM-HPNA-NICSO Opioid Conversion – 2025 Dedicated opioid-conversion guidance for adults with cancer, including pre-conversion, conversion and post-conversion assessment. Open 2025 cancer conversion guidance

ASCO Palliative Care for Patients With Cancer – 2024 Supports early interdisciplinary palliative-care involvement alongside active cancer treatment for appropriate patients. Open ASCO palliative guidance

AAHPM Essentials 3: Pain Assessment & Management – 2026 Current American Academy of Hospice and Palliative Medicine educational resource focused on pain in serious illness and palliative care. Open AAHPM pain resource

AAHPM Essential Practices in Serious Illness – 2026 Current hospice and palliative medicine resources for whole-person assessment and serious-illness care. Open AAHPM serious-illness resource

FDA 2025 Opioid Long-Term-Use Labeling Changes Updated labeling emphasizes long-term risks, overdose-reversal-agent discussions, safe discontinuation and interactions with other CNS depressants. Open FDA opioid safety update

FDA Gabapentin / Pregabalin Respiratory-Depression Warning Serious breathing problems can occur in patients with respiratory risk factors, particularly when gabapentinoids are combined with opioids or other CNS depressants. Open FDA gabapentinoid warning

Supporting GlobalRPh resources

Related specialties, laboratory support and evidence tools

Related specialty portals

Organ function / medication support

Statistics / directories

Why older opioid conversion pages remain accessible during the update process

GlobalRPh’s opioid calculators remain useful because they expose the assumptions and uncertainty involved in rotation rather than presenting a single “magic” conversion number. We are retaining those tools while updating the conversion evidence, currently marketed products, safety labeling and population-specific guidance so longstanding links remain available during the modernization process.

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Clinical use: GlobalRPh opioid-conversion calculators, medication tables and educational articles are intended to support, not replace, individualized pain assessment, current product labeling, current cancer/palliative or chronic-pain guidance, organ-function review, drug-interaction assessment, monitoring, specialist consultation when indicated and professional judgment. Equianalgesic values and MME factors are estimates and should not be interpreted as automatically safe replacement doses.

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Alphabetical Listing of individual drugs

a b c d e f g h i j k l m
n o p q r s t u v w x y z

Common LAB Values Renal Dosing