Pain
World Health Organization Analgesic Ladder Approach For Relief of Cancer Pain ⁵

Mild to Moderate Pain (1-3)
Non-opioids are the first choice of treatment for this type of pain. This includes medication such acetaminophen (Tylenol^®) or a nonsteriodal anti-inflammatory drug. Adjuvant drugs may be added if a specific need is identified.

Moderate to Severe Pain (4-6)
Patients with this type of pain or those who have not responded to the first step should receive an opioid used for moderate pain. These medications may include codeine, hydrocodone, dilhydrocodeine, oxycodone, propoxyphene and tramadol. Acetaminophen or a nonsteriodal may be added. Adjuvant drugs may also be added as indicated.

Severe Pain (7-10)
Patients with severe pain or who have not achieved pain relief from the previous step will usually receive an opioid. Opioids used may include morphine, oxycodone, hydromorphone, methadone, levophanol or fentanyl. A non-opioid analgesic and/or adjuvant drug may be added as the situation indicates.

Breakthrough Pain
The use of short acting morphine is usually the drug of choice for breakthrough pain, although other drugs may be used to treat the pain. Breakthrough pain occurs between doses of pain medicine. This type of pain may be an indication that your pain medicine should be increased if it is happening often. This pain may also be an infrequent event associated with increased activity. It is important to remember that mild, moderate and severe pain will be different for each person. You may describe your pain as moderate and another person could describe the pain as severe. The plan for your pain control will be based on how you describe your pain. Your description of pain does not necessarily mean your cancer is getting worse.