Choosing an analgesic

• For most types of pain, it is usual to start a non-opioid analgesic on a PRN basis, progressing to regular use
• Some non-opioid analgesics may be used in conjunction with one another (e.g. paracetamol and NSAIDs) or in conjunction with opioids for added analgesic effect (see below)
• If non-opioid analgesics do not control pain effectively opioid analgesics may be helpful. Opioid analgesics can be given PRN or regularly. Strong opioids do not have a dose limitation.
  They should be started low and the dose should be titrated until effective analgesia is achieved or side effects prevent further escalation. If side effects are problematic these can be treated with other medication, or the opioid can be changed to a different preparation with a different side-effect profile; likewise, if analgesia is sub-optimal changing the opioid may help
• If a patient is prescribed regular opioids it is important to prescribe additional PRN analgesia in a suitable form and dose for breakthrough analgesia
• All analgesic regimens should be regularly reviewed, particularly during titration