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Table 1 Categorization of pain, appropriate analgesics, side effects, and co-medication

From: Testing a pain self-management intervention by exploring reduction of analgesics’ side effects in cancer outpatients and the involvement of family caregivers: a study protocol (PEINCA-FAM)

WHO analgesic ladder steps Score 0/10 on NRS Category of analgesic Most important analgesic Most important side effects Co-medication
1 (mild pain) < 3 Non-opioids - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) - gastrointestinal complications
- heart attack
- stroke
- skin or allergic reactions
- Proton pump inhibitor
- Antihistamines
- Corticosteroids
- Acetaminophen
- Metamizole
- renal and liver toxicities
- Hepatotoxicity
- skin or allergic reactions
- Antihistamines
- Corticosteroids
2 (mild to moderate pain) 3–6 Weak opioids
± Non-opioids
- Tramadol
- Tilidine + Naloxone
- Constipation
- Nausea
- Pruritus
- motor and cognitive impairment
- respiratory depression
- sedation
- Laxatives
- Anti-emetics
- Corticosteroids
- Antihistamines
- Major tranquillizers
- Psychostimulants
3 (moderate to severe pain) > 6 Strong opioids
± Non-opioids
- Morphine
- Hydromorphone
- Oxycodone
- Methadone
- Levorphanol
- Pethidine
  1. Note. Categorization of pain, appropriate analgesia, side effects and co-medication according to the WHO-sequential three-step analgesic ladder [5,6,7, 63, 70, 71]
  2. Abbreviations: WHO World health organization, NRS Numeric rating scale, NSAIDs Nonsteroidal anti-inflammatory drugs