1. By the clock
Cancer pain is continuous – Use regular analgesia appropriate dose intervals – not just p.r.n.
2. By the ‘ladder’
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 adviceThe ‘ladder’ has no ‘top rung’ as there is no maximum dose for strong opioids
3. By the mouth
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