The principles governing analgesic use are summarised in the WHO Method for Relief of Cancer Pain:

	• By mouth, where possible
	• By the clock: Regular, as well as p.r.n. dose
	• By the ladder:
		o After assessing the severity of pain, the analgesic ladder can be used to identify appropriate analgesics for the level of pain.
		o The patient should be reassessed and analgesia administered in a step-wise manner working up the ladder until the patient’s pain is managed.
		o Similarly, if the severity of pain is reduced, a patient’s level of analgesics should move back down the ladder, eventually stopping treatment when pain resolves.
		o Alternative analgesia and adjuvants or non-pharmacological interventions should be considered at each level of the analgesic ladder.
	• Individual dose titration: Titrate dose against effect, with no rigid upper limit for most opioids except buprenorphine, codeine and tramadol.

https://web.archive.org/web/20200820090133/http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Documents%20and%20links/Palliative%20symptom%20guide%20-%20electronic3.pdf