The Scottish Intercollegiate Guidelines Network (SIGN) updated a clinical guideline entitled “Control of pain in adults with cancer”. 

An outline of the contents (drug therapy related) in this guideline for the treatment of cancer induced pain include:

The WHO analgesic ladder is always present:

WHO analgesic ladder

WHO analgesic ladder step Score on numerical rating scale Analgesics of choice
1 (mild pain) <3 out of 10 paracetamol and NSAIDs
2 (mild to moderate pain) 3 to 6 out of 10 weak opioids( eg codeine or dihydrocoideine) plus paracetamol and NSAIDs
3 (severe pain) > 6 out of 10 strong opioids (eg morphine, alfentanil, diamorphine, fentanyl, hydromorphone or oxycodone) plus paracetamol and NSIDs

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