In 2001, the European Association for Palliative Care (EAPC) published a revised set of guidelines on the use of morphine and alternative opioids in cancer pain. (1) The guidelines, compiled by an international committee of fifteen experts, are presented as a series of 20 recommendations. In each instance, the strength of evidence supporting a recommendation is noted. Ten recommendations are based solely on reports or opinion, in the absence of directly applicable, good-quality clinical studies. A further 5 recommendations are based on the evidence of well-conducted clinical studies, but are not supported by randomised clinical trials. How relevant and useful are these guidelines in 2004 and beyond? Is it possible, or even desirable, to produce a set of guidelines that are equally valid and applicable across all European countries? Whilst many of the recommendations are undoubtedly scientifically robust, others are more questionable. The EAPC recommendations will be critically reviewed in the context of current knowledge and practice.

References
1. Expert Working Group of the Research Network of the European Association for Palliative Care. Morphine and alternative opioids in cancer pain: the EAPC recommendations. British Journal of Cancer (2001) 84 (5), 587 - 593