Pain Formulary PrintPrint23AugPRESSFINAL _2017
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A Stepped Approach To <strong>Pain</strong> Prescribing<br />
The WHO analgesic ladder was developed to support<br />
patients with cancer pain. The underlying principle was<br />
that medications should be used sequentially, according to<br />
the patient’s reported pain intensity i.e. for mild pain nonopioid<br />
medication should be prescribed, with weak opioids<br />
for moderate pain and strong opioids for severe pain.<br />
Prescribing for persistent pain shouldn’t be determined by<br />
reported pain intensity (see above). It is rational to start<br />
with non-opioid drugs, if these have evidence for efficacy<br />
for the condition being treated. This should always be<br />
accompanied by general condition specific advice for acute<br />
pain and for persistent pain advice about exercise, sleep,<br />
pacing activity and strategies to improve function. Trials<br />
of weak and strong opioid therapy can be considered for<br />
some patients if:<br />
• There is a well-defined pain diagnoses.<br />
• Symptoms persist despite first line treatments.<br />
• The patient can be followed up within two weeks to<br />
evaluate effectiveness.<br />
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<strong>Pain</strong> <strong>Formulary</strong> PrintFinal _<strong>2017</strong>.indd 7 23/08/<strong>2017</strong> 14:12:46
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