1) ‘By mouth’ – administer analgesics orally whenever possible. Alternative routes should be reserved for patients who have gastrointestinal problems.

2) ‘By the clock’ – they should be given on a regular basis rather than on an ‘as needed’ basis. Analgesics given at fixed time intervals based on the duration of action of the drug result in better pain management. The subsequent dose should ideally be administered before the previous one has worn off. The dose of the drug is titrated to effect/side effects and some patients may need rescue analgesia for breakthrough and incident pain.

3) ‘By the ladder’ – pain is subjective and patients should be treated with analgesics as per ‘their’ intensity of pain. Patients’ pain should be evaluated using simple pain evaluation scales and treated accordingly. Use only one drug from the respective group and if ineffective, use stronger drugs from the group rather than replacing it by a similarly efficacious drug.

4) ‘For the individual’ – pain doses should be specifically tailored to individuals as they demonstrate variable response to drugs. Apart from strong opioids, most analgesic drugs have a standard dosing regime with a maximum allowable safe dose. Strong opioids on the other hand are titrated to effect in individual patients; i.e. optimum pain relief with tolerable side effect profile.