Table 1 Key elements of the MAPP

Multimodal analgesic prescribing

Reduced variability between prescribers

Multimodal opioid sparing regime (41,42)

• Strong opioid

• Weak opioid

• NSAID*

• Paracetamol

Analgesics prescribed on a fixed schedule

Assessment of pain

Use of 11-point numerical rating scale for pain intensity

Pain intensity rating ≥4 (pain or rest) indicative of breakthrough pain

Frequency of pain intensity assessment

• Two-hourly when awake

• Four-hourly when asleep

• Reassessment of pain intensity within 30 minutes of treatment for breakthrough

Management of breakthrough pain and prevention/control of analgesic side effects

Availability of analgesics prescribed as PRN

Algorithmic support for treatment decisions

Availability of pre-emptive treatments for nausea and constipation

Escalation plan if breakthrough pain persists

Review of causation and plan of treatment to prevent recurrence