Palliative Pain

Question 1

Describe the WHO analgesic ladder.

Answer 1

Step 1 - non-opioid +/- adjuvant analgesic
Step 2 - weak opioid for mild to moderate pain, plus non-opioid +/- adjuvant analgesia
Step 3 - strong opioid for moderate to severe pain, plus non-opioid +/- adjuvant analgesia

Question 2

Name some non-opioid pain relief drugs.

Answer 2

Paracetamol
Aspirin
NSAIDs - especially for soft tissue and bone pain

Question 3

Name some weak opioid painkillers.

Answer 3

Co-codamol

Tramadol - part opioid and part presynaptic uptake blocker of monoamines

Question 4

Name some strong opioid painkillers.

Answer 4

Oral morphine - immediate effects - Oramorph or sevredol
Oral morphine - slow release - MST Continus
Subcut morphine - immediate effect via bonus injection
Subcut morphine - sustained effect via syringe driver
Oral oxycodone - can be immediate or slow release form
Subcut oxycodone - for sustained effect via syringe driver
Subcut alfentanil - sustained effect via syringe driver - good in renal failure
Topical fentanyl patch - steady release