Cancer Patient

With Pain

Assessment – History / Physical Examination / Investigation

Diagnosis
 Type – Nociceptive / Neuropathic / Mixed
 Source – Cancer – related / non cancer – related
 Severity – Pain Score

Pain Score

Mild Cancer Pain Moderate Cancer Pain Severe Cancer Pain

( Pain Score 1 – 4 ) ( Pain Score 5 – 6 ) ( Pain Score 7 – 10 )

WHO LADDER WHO LADDER

WHO LADDER STEP II STEP III
STEP I
 Tramadol  Morphine
 Paracetamol
 Codein  Oxycodone
 NSAIDS
 Dihydrocodein  Fentanyl
 Cox-2
 non – opioids  non – opioids
inhibitors 
 adjuvants  adjuvants
adjuvants

Pain Pain
Pain Control
Control Control
No No No
Yes
Yes Yes

Refer to Palliative
Cate Team / Pain
Follow - Up Specialist