Opioids and the World Health Organization pain ladder

Opioids constitute the most important group of drugs in the management of pain in palliative care. Morphine is still the drug of choice and considered the ‘gold standard’ in opioid prescribing in children. Other opioids have some pharmacological differences that may confer some advantages (and disadvantages) in specific types of pain or particular clinical scenarios. Opioid prescription must follow World Health Organization (WHO) approach to pain management principles. Understanding the rationale behind these principles improves the achievement of an individualized prescription to ease the pain of a particular patient. Opioid initiation, titration, breakthrough pain handling, and opioid substitution are essential aspects of opioid management. Their knowledge constitutes a core skill in paediatric palliative pain medicine.