1. }   Recommended Analgesia for Adult Patients Pain Severity 1. Mild
Assess the level of pain and start at the appropriate point of pain severity 1.
Mild 2.
Moderate 3.
Severe
Reg. Paracetamol 1g QDS. Max 4 gram daily.
PO/PR/IV (IV only if patient is NBM).
If pt wt <50 kg dose IV at 15mg/ kg every 4-6hrs (max 60mg /kg in 24hrs) 
Reg. NSAID (if not contraindicated *):
Ibuprofen 400mg PO TDS - QDS
* Cautions may include; renal disease, oral anticoagulation, history of hypersensitivity to NSAIDs, history of gastric ulcers, asthma For a full list refer to the BNF.
Reg. Weak Opioid:
Codeine 30-60mg PO QDS
Or Tramadol mg PO QDS. Consider a reduced dose in the elderly e.g. 50mg TDS Tramadol is contraindicated in patients with a history of epilepsy. 
Strong Opioid:
Either;
Reg. Zomorph MR PO & PRN breakthrough Oramorph if unsedated.
IV titrate aliquots - see protocol
PRN IM/oral hourly protocol
PCA protocol
Epidural protocol
With PRN opioid for breakthrough
With PRN Oramorph for breakthrough }
Titrate dose against pain score to achieve desired therapeutic effect and monitor for signs of adverse events.
Caution with dose and frequency in renal impairment.
Consider; Prophylactic naloxone/ anti-emetic/ laxative
Consider need for adjuvant treatment and/ or referral to specialist pain team where appropriate
N.B. Combined regular and PRN prescribing of pain relief is better at preventing pain
Date Approved: Oct 2011 Review Date: Oct 2012