Principles of CMP Management2,3




The basic premise of cancer pain management according to the World Health Organization (WHO) involves five essential principles which are:

  • By the mouth.
  • By the clock.
  • By the ladder.
  • For the individual.
  • With attention to detail.
    • These principles focus on the Three-Step Analgesic Ladder with attention given to oral rather than IV therapy, and medication administration on a scheduled "around-the-clock" basis with additional "as-needed" doses for breakthrough pain. As in any health management therapies, pain management should focus on the patient and the proper assessment of the condition since needs may be highly individualized.

    Three-Step Analgesic Ladder
    (World Health Organization, 1990)
    Step 1 Mild Pain:  Non-Opioid +/- Adjuvant
    1.  Acetaminophen (APAP)
    2.  Aspirin
    3.  NSAIDs
    Step 2 Moderate Pain:  "oral" Opioid + Non-Opioid +/- Adjuvant
    1.  Codeine
    2.  Oxycodone
    3.  Hydrocodone
    Step 3 Severe Pain:  "strong" Opioid +/- Non-Opioid +/- Adjuvant
    1.  Morphine
    2.  Hydromorphone
    3.  Fentanyl
    4.  Meperidine
    5.  Methadone

    Back to Top.