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Protocol pain medication

The protocol advocated by moveUP is the pain ladder of the WHO.

The three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder”.

  • By the clock:
    • To maintain freedom from pain, drugs should be given “by the clock” or “around the clock” rather than only “on demand”. This means they are given on a regularly scheduled basis. The frequency will depend on whether it is a long- or short-acting preparation.
  • By the mouth:
    • The oral route is usually the preferred route for ease of use in a variety of care settings.
  • By the ladder:
    • If pain occurs there should be prompt administration of drugs in the following order until the patient is free of pain:
      • non-opiods (e. g. paracetamol)
      • as necessary, mild opiods (e. g. codeine)
      • then strong opiods (e. g. morphine or hydromorphone)
Is the WHO analgesic ladder still valid? | The College of Family Physicians  of Canada

Pain medication

At moveUP we believe the rehabilitation should be as pain free as possible for the patient. Pain medication should be prescribed to be given at fixed time intervals with extra doses that can be taken in case of acute pain.

Step 1 medication


TypeHow many mgHow manyHow longContra-indications
Paracetamol1000mg1-4/d14d postop• severe liver problems
• severe renal impairment


TypeHow many mgHow manyHow longContra-indications
Diclofenac retard (NSAID)75mg2/d
14d postop
14-30d postop
To be gradually diminished based on inflammation parameters.
• stomach ulcers
• renal impairment
Etoricoxib (Arcoxia)60mg2/d10 days postop
• stomach ulcers
• renal impairment

Step 2: weak opioid

TypeHow many mgHow manyHow longContra-indications
Tramadol (Contramal)50 mg1-3/dwhen in severe pain

Step 3: strong opiod

TypeHow many mgHow manyHow longContra-indications
Oxycodon5mg1-3/dwhen in severe pain not controlled by tramadol

Updated on July 8, 2021

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