Evidence-based management of Chronic Pain (Palliative) according to Uganda Clinical Guidelines 2023

Step 1: Mild Pain

Paracetamol 10-15 mg/kg every 6 hours. Ibuprofen 5-10 mg/kg every 6-8 hours (>3 months).

Step 2/3: Moderate-Severe

Morphine every 4 hours. 6-12 months: 0.2 mg/kg. 1-2 years: 0.2-0.4 mg/kg. 2-12 years: 0.2-0.5 mg/kg.

Adjuvants (Neuropathic)

Amitriptyline 0.2-0.5 mg/kg (max 1 mg/kg) nocte.

Step 1: Mild Pain

Paracetamol 1 g every 6 hours OR Ibuprofen 400 mg every 8 hours.

Step 2: Moderate Pain

Add Weak Opioid: Codeine 30-60 mg every 4 hours OR Tramadol 50-100 mg every 6 hours.

Step 3: Severe Pain

Strong Opioid: Morphine (liquid/tablet) starting at 2.5-5 mg every 4 hours. Titrate dose by 30-50% if pain not controlled.

Adjuvants (Neuropathic)

Amitriptyline 12.5-25 mg nocte (max 75 mg).

Adjuvants (Muscle Spasm)

Diazepam 5-20 mg nocte.