Most cancer pain responds to pharmacological measures, and successful treatment is based on simple principles that have been promoted by the World Health Organisation1 and extensively validated.2 3 Oral administration of analgesic drugs is preferred, and analgesics are given regularly to prevent recurrence of pain, often for months or even years. A step by step approach to the choice of drug is recommended, based on the “analgesic ladder” (fig 1). The first step is a non-opioid analgesic such as aspirin, paracetamol, or a non-steroidal anti-inflammatory drug. At the second step a weak opioid such as codeine is added, and when this proves inadequate a strong opioid is substituted for the weak opioid. Fig 1 Analgesic ladder for control of pain Morphine is the preferred strong opioid analgesic. The dose is titrated up to achieve adequate relief of pain. There is no upper limit. Dose requirements may vary 1000-fold, but few patients need daily doses above 200-300 mg.4 Adjuvant analgesics such as antidepressant or anticonvulsant drugs, used alone or in conjunction with a conventional analgesic, have an important role in some patients.5 Morphine has long been feared by both the general public and doctors.6 Underlying the fear is a mistaken belief that the problems associated with abuse of opioids are inextricably linked with their therapeutic use. Concerns about addiction, excessive sedation, and respiratory depression have resulted in widespread avoidance or underdosing. Yet extensive, carefully documented clinical experience has shown that these fears are unfounded.7 Regular doses of morphine may be indicated and safely instituted early in the course of a patient's illness and continued for many months. Alternatively, some patients may be treated with morphine for short periods and, when their pain ameliorates, can reduce the dose and discontinue it without difficulty. Daytime drowsiness, dizziness, or mental …