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Analgesic Ladder for Acute Pain Management Cheat Sheet by

Describe the analgesic according to the pain score

Mild ( Pain score 1-3)

PRN (as needed)
No medication or Parace­tamol (PCM) 1g QID
PCM &/or NSAID or COX2 inhiibitor

Moderate (Pain 4-6) score

PRN (as needed)
Opioid Tramadol 50-100mg TDS-QID
Additional Tramadol 50-100mg (Max total dose:4­00m­g/day)
+- PCM 1g QID
+- NSAID/COX2 inhibitor

Severe (Pain score 7-10)

PRN (as needed)
IV/SC Morphone 5-10mg 4H or Aqueous Morphine 5-10mg 4H or IR Oxycodone 5-10mg 4-6H
IV/SC Morphine 5-10mg or Aqueous Morphine 5-10mg or IR Oxycodone 5-10mg
+- PCM 1g QID
+- NSAID/COX2 inhibitor


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