According to the WHO Guideline Cancer Pain Relief (2nd Ed) pain treatment should go in three steps:
: (mild pain) non-opioid analgesics (e.g. paracetamol), to which if necessary an adjuvant can be added
when a non-opioid no longer adequately controls the pain, an opioid analgesic should be added:
: (mild to moderate pain) weak acting opioid analgesics, to which if necessary non-opioid analgesics and adjuvants can be added
if the pain is still persisting or increasing:
: (moderate to severe pain) strong acting opioids, to which if necessary non-opioid analgesics and adjuvants can be added.
If the pain is increasing, the dosage of the opioid should be increased in steps until the patient is free of pain. The effective analgesic dose of morphine varies considerably and ranges from as little as 5 mg to more than 1000 mg every four hours. The effective dose varies partly because of individual variations in systemic bioavailability. The correct dose is the dose that works.
Five principles on managing pain
Also, the five principles on managing pain are part of this method:
1.- By mouth - meaning that oral administration if possible is preferred
2.- By the clock - meaning that administration should be given in regular intervals and one should not wait for the pain coming back
3.- By the ladder - as explained above
4.- For the individual - as opioid kinetics vary tremendously from person to person, one cannot prescribe standard dosages
5.- Attention to detail should be given
WHO. Use of controlled medications in pain treatment. Internet. Accessed on January 24, 2016.