World Health Organisation recommendations for the management of cancer pain

>>by the mouth – i.e. using the oral route for all drugs including morphine and other opioids unless patient is vomiting, semi-conscious, has dysphagia etc.

>>by the clock (regular administration) – persistent pain requires preventative treatment and as needed (prn) analgesia only is not acceptable

>>by the ladder (WHO analgesic ladder)

Step 1: Non-opioid +/- adjuvants

Step 2: Weak opioid + non-opioid +/- adjuvants

Step 3: Strong opioid + non-opioid +/- adjuvants

* Non-opioid = Paracetamol/NSAIDs

* Weak opioid = e.g. cocodamol 30/500

* Strong opioid = e.g. morphine, fentanyl, oxycodone