Table 1.

10-point scoring system for analgesic prescribing.

Step of WHO ladder	Primary analgesic	Dosing	Non opioid medication	Adjuvant medication	Score
1	Non opioid	Regular	–	No	1
		Prn	–	No	3
	Non opioid	Regular	–	Yes	0
		Prn	–	Yes	2
2	Weak opioid	Regular	No	No	3
		Prn	No	No	7
	Weak opioid	Regular	Yes	No	1
		Prn	Yes	No	5
	Weak opioid	Regular	No	Yes	2
		Prn	No	Yes	6
	Weak opioid	Regular	Yes	Yes	0
		Prn	Yes	Yes	4
3	Strong opioid	Regular	No	No	3
		Prn	No	No	7
	Strong opioid	Regular	Yes	No	1
		Prn	Yes	No	5
	Strong opioid	Regular	No	Yes	2
		Prn	No	Yes	6
	Strong opioid	Regular	Yes	Yes	0
		Prn	Yes	Yes	4

*Note: One point to be added for (Maximum score 10):

Use of two different opioids together.

Inappropriate use of medication (e.g. patients self injecting Pethidine).

Prescribing of a strong opioid analgesic without a laxative.

A HIGH score=less than optimal prescribing.

A LOW score=more optimal prescribing.

Steps of WHO analgesic ladder [14].

Step 1.Simple analgesics, e.g. paracetamol (1 g four times a day), +/− adjuvants.

Step 2.Weak opioids, e.g. codeine, dextropropoxyphene, +/− paracetamol,+/− adjuvants.

Step 3.Strong opioids, e.g. morphine,+/−paracetamol,+/− adjuvants.