Prescribe the appropriate medication at the appropriate dose - no one optimal dose, no one maximal dose; goal is pain relief without unmanageable side effects. View the WHO step ladder pain management.
Administer by appropriate route - choice dictated by clinical situation. IV/SQ best for pain crisis. Adjust dose when changing route - e.g., ratio of parenteral to oral morphine is about 1:3 (10 mg IV is equianalgesic to 30 mg oral morphine). View the equianalgesic doses of opioid analgesics table.
Schedule appropriate dosing interval - depends on opiate and route (click to see dosing intervals for common opiates) range is q 1-2 hours for IV and q72 hours for transdermal. Goal: prevent pain recurrence and minimize number daily doses.
Prevent persistent pain and relieve breakthrough pain - use around the clock dosing and as-needed for rescue or breakthrough pain.
Titrate dose aggressively - indications: inadequate pain relief, end of dose failure, frequent use of prn rescue doses. For severe pain increase dose by 50-100%, for moderate pain increase by 25-50%. Frequency of dose escalation depends on opioid and route.View the equianalgesic doses of opioid analgesics table.
Prevent and manage side effects - especially constipation, nausea, sedation, confusion.