Medical therapy constitutes one of the main aspects of pain treatment. The therapy is carried out according to the ‘pain ladder’ guidelines established by the World Health Organization (WHO). Depending upon pain intensity, different combinations of analgesics - such as pain-relieving medications and patches - are used to provide pain relief.
Pain relieving results can be enhanced by combining analgesic drugs with so-called co-analgesics, which include different types of medications - for example, antidepressants, anticonvulsants, corticosteroids, laxatives and antiemetics, among others.
When implementing the WHO pain ladder guidelines, the following fundamental rules should be observed:
1.) Generally, the therapy for chronic pain should be carried out with sustained-release oral medications if possible.
2.) The schedule for taking prescribed substances should be arranged in a patient friendly manner, and at the same time should ensure that proper pharmacological intervals are maintained.
When treating chronic pain, the administration of medication should occur before the pain-relieving effects of the previous dose have worn off. This is the only way to ensure that the patient is not reminded of the pain and doesn’t develop a fear of it.
3.) Medications for chronic pain are to be taken on a regular, fixed schedule. Dosage instructions, such as "take as necessary" or "take when experiencing pain" are obsolete. Only acute breakthrough pain can be treated with an "as needed" regimen.
4.) The dosage of analgesics should be determined by the intensity of the pain experienced by the patient, using a pain scale such as the Visual Analog Scale (VAS) 1-10, where 0 represents "no pain" and 10 "worst pain imaginable".
5.) Pain levels should be consistently monitored so that the patient always receives the proper dosage of medication.
6.) Any possible side effects should be treated with a concomitant therapy.
In situations where acute pain is present, the administration and dosage of medication is adjusted accordingly, and analgesics may be given via infusion.