Analgesia — WHO Ladder

Analgesics

Acute and chronic pain management.

Regimens

  • Step 1

    Paracetamol 1 g PO/IV QDS ± NSAID (ibuprofen 400 mg TDS)

  • Step 2

    Add weak opioid: codeine 30–60 mg QDS or tramadol 50–100 mg QDS

  • Step 3

    Strong opioid: morphine IR 5–10 mg PO/SC 4-hourly, titrate; convert to MR

  • Neuropathic

    Amitriptyline 10 mg nocte or gabapentin 100–300 mg TDS or pregabalin 75 mg BD

Monitoring

  • Pain score, sedation, RR, bowels
  • Renal function for NSAIDs/opioids

Common prescribing errors

  • NSAID in CKD, HF, GI bleed risk
  • Codeine in <12 y / breast-feeding
  • Failure to prescribe laxative with opioid
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