Use of analgesics

These should be given by the clock and administered according to the three-step method: Step 1: Mild pain

Start with basic non-opioid analgesics: aspirin 600-900 mg (o) 4 hourly (preferred) or paracetamol 1 g (o) 4 hourly Step 2: Moderate pain

Use low dose or weak opioids or in combination with non-opioid analgesics (consider NSAIDs): add morphine 5 to 10 mg (o) 4 hourly or oxycodone up to 10 mg (o) 4 hourly or

30 mg, rectally, 8 hourly Step 3: Severe pain

Maintain non-opioid analgesics. Larger doses of opioids should be used and morphine is the drug of choice: morphine 10 mg (o) 4 hourly or morphine SR tabs or caps (o) 12 hourly

• Give dosage according to individual needs (morphine SR comes in 10, 20, 30, 50, 60, 100, 200 mg tablets or capsules).

• The proper dosage is that which is sufficient to alleviate pain.

• Give usual morphine 10 mg with first dose of morphine SR and then as necessary for 'rescue dosing'.

• Gauge the probable dose of the long-acting morphine from the standard dosage.

• To convert to morphine SR calculate the daily oral dose of regular morphine and divide by 2 to get the 12 hourly dose.

• Do not crush or chew the tablets or capsules.

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