Research done on cancer cells indicate that these cells can respond to orally administered analgesics and adjuvants (Hanks 1). This prompted the WHO to develop a program that came to be known as the analgesic ladder which involves a set of sequential steps in the use of analgesics in the management of cancer pain. This program allows different governments and health institutions the flexibility in choosing specific drugs for use. This also involves integrating the disease-modifying remedies and non-drug approaches with the symptomatic treatment drugs used in the management of cancer pains. Through this program, several oral opioids have been employed in the treatment of moderate and severe pains (Hanks 1). Under this program, a set of guidelines were developed concerning the use of morphine. It is documented that the first choice opioid for severe pain related to cancer should be morphine. This should be administered through the oral route in two forms (that is) the normal and the modified release formulations. The guidelines also give the formal method for dose titration which involves the use of the normal release morphine dose. In this case, the drug is administered every four hours. The same dosage is also given for breakthrough pain. The total daily dose of morphine is then reviewed daily to allow for adjustments in the regular dosage (Hanks 2).
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