1. By the clock
Cancer pain is continuous – Use regular analgesia with appropriate dose intervals – not just P.R.N.
Cancer pain is continuous – Use regular analgesia with appropriate dose intervals – not just P.R.N.
The ‘ladder’ has no ‘top rung’ as there is no maximum dose for strong opioids.
If pain is still a problem with high doses of strong opioid, (greater than 300mg morphine equivalent /24hrs), or severe side effects, reconsider the cause of the pain, and/or seek specialist palliative care advice.
The oral route is preferred for all steps of the analgesic ‘ladder’ unless there is a clinical reason why absorption of drugs given orally will not be effective.
Use the links below for further information about each Step of the Ladder: