Use WHO Analgesic ladder (in normal renal function):
- Step 1: Paracetamol 1g QDS (not soluble as high Na+ content)
- Step 2: Paracetamol 500mg + codeine 30mg, 2 tablets QDS or tramadol 50-100mg QDS +/- regular paracetamol
- Step 3: Morphine 5-10mg 4 hourly and PRN, titrate every 48 hours if pain not controlled
Seek advice if renal function poor, opioid toxicity or inadequate pain control.
For further information see: Chapter: Pain and Chapter: Renal Failure