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Oncology
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Cancer Pain Management (WHO Ladder)
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WHO ladder: non-opioid → weak opioid → strong opioid.
Decision
Outcome
Decision
Cancer pain severity?
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Mild → non-opioid (acetaminophen, NSAID)
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Moderate → weak opioid (codeine, hydrocodone, tramadol) + non-opioid
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Severe → strong short-acting opioid (morphine, hydromorphone) + non-opioid
Outcome
Non-opioid analgesics + adjuvants (anticonvulsants, antidepressants for neuropathic)
Outcome
Step 2 of WHO ladder
Decision
After titration with short-acting opioids — next step?
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Calculate total daily dose, convert to long-acting (fentanyl patch, oxycodone CR) + breakthrough short-acting
Outcome
Long-acting opioid for baseline + short-acting for breakthrough; bowel regimen mandatory
Adjuvants for bone pain (bisphosphonates, RT), neuropathic (gabapentin, TCAs).