Contents

Search

World Health Organization (WHO) pain ladder

Management: 1) Step 1 (mild pain) a) aspirin 650 mg PO b) tylenol 650 mg PO c) NSAIDs - ibuprofen 200-800 mg PO - naproxen 250-275 mg PO - indomethacin 25-75 mg PO - piroxicam 10-20 mg PO 2) Step 2 (moderate pain) a) acetaminophen combinations 1] tylenol#3, tylenol#4 2] Vicodin, Lorcet 3] Percocet, Endocet b) codeine c) hydrododone d) morphine IR, 15-30 mg PO, 1-10 mg/hr IV, 4-15 mg SQ 3) Step 3 (severe pain) a) morphine (sustained release) 15-30 mg PO b) oxycodone (immediate-release) 10 mg PO c) OxyContin (sustained-release 10-20 mg PO d) hydromorphone (Dilaudid) 4-8 mg PO, 1-2 mg IV e) methadone 5-10 mg PO, 2.5 mg IV f) Levorphanol 2-4 mg PO g) Fentanyl 25 mg PO, transdermal patch 25 ug/hour Doses are guidelines & must be individualized

Related

pain management in palliative care

General

clinical practice guideline (CPG)

References

  1. Levy MH Pharmacologic treatment of cancer pain. N Engl J Med 1996; 335:1124 PMID: 8813044
  2. National Comprensive Cancer Network. Adult cancer pain. Clinical Practice Guidelines in Oncology, version 2 http://www.nccn.org/professionals/physician_gls/PDF/palliative.pdf