Chronic cancer pain is generally treated by the philosophy of €by mouth, by the clock and by the ladder€.

• By mouth: the oral route should be first line, but alternative means of administration may be warranted
• By the clock: regular (titrated) doses of analgesia should be given at the specified time (e.g. every 12 hours), regardless of whether pain is occurring or causing distress. 'As required' (prn) doses can be used, but should not form the basis of pain relief
• By the ladder: The WHO pain ladder should be used for reference.