://module2 The WHO method                                             page 2/9

Principles of pain management                                        <<previous      next>>

Patients presenting with pain should be assessed and then placed on suitable treatment.  The WHO approach to pain management has been shown to be effective in relieving pain in 90% of patients with cancer [1] and 75% of terminally ill cancer patients [2].  There are five principles of cancer pain management.  Drug therapy should be administered:

  1. By the mouth:Oral administration is convenient, non invasive, cost effective and well tolerated in most patients.
  2. By the Clock:Regular analgesia (4-6 hourly) with breakthrough doses when needed provide a more constant level of drug in the body and reduce pain recurrence.
  3. By the ladder:Patients should move up the ladder as necessary, but may also move down the ladder if pain decreases.
  4. For the individual:Patients presenting with moderate to severe pain can be started on a higher step in the ladder.  Some patients will not be able to tolerate oral medication and may need other preparations.  Patients may need non drug therapies.  There is no standard dose of opioid - morphine requirements can vary from 5mg to 1000mg every four hours.
  5. With attention to detail:Total analgesia usage should be monitored every 24 hours, and the maintenance dose adjusted accordingly.  Breakthrough doses should be adjusted in line with changes to regular medication. New pain should be assessed promptly to ascertain the cause and to allow treatment.  Patients should be informed of possible adverse drug effects.

[1] Ventafridda V, Caraceni A, Gamba A.
Field-testing of the WHO Guidelines for Cancer Pain Relief: summary report of demonstration projects. In: Foley KM, Bonica JJ, Ventafridda V, editors. Proceedings of the Second International Congress on Pain. Vol. 16. Advances in pain research and therapy. New York: Raven Press, Ltd.; 1990. p. 451-64

[2]Grond S, Zech D, Schug SA, Lynch J, Lehmann KA.
Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manage 1991; 6(7):411-22

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