Analgesic ladder

Figure 2.4 Three-Step Analgesic Ladder of the World Health Organization.

Jadad, A.R. and Browman, G.P. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation, JAMA 1995, 274, 1870-1873. 

In a review of the use of tramadol in musculoskeletal pain the authors concluded that tramadol can be used at Step 2 of the analgesic ladder, since its efficacy, alone or in conjunction with NSAIDs, in the management of chronic musculoskeletal pain without increasing the frequency of adverse effects has been confirmed (2,3). 

This publication was groundbreaking, not only in its discussion of the lack of appropriate cancer pain management worldwide, but in its overall recommendations for managing cancer pain. The concept of the three-step analgesic ladder is introduced, which divides pain ratings into three categories mild, moderate, or severe, with medication selection based on a step-up approach. When this step approach to pain management is employed, up to 90% of all cancer pain can be relieved. 

Regardless, the popularity of the WHO analgesic ladder in various fields of medicine is evident [7],... 

Azevedo SL, Ferreira K, Kimura M, et al. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it Support Care Cancer 2006 14 1086-93. 

While simplistic in nature, the WHO analgesic ladder was considered to be a successful therapeutic advance as it provided an organized approach to pain assessment and management on a global scale [3]. The major drawback associated with the WHO stepwise... 

Foley KM. 2006. Appraising the WHO Analgesic Ladder on Its 20th Anniversary, www.whocancerpain. 

Non-opioid analgesics (NSAIDs, COX-2 inhibitors, APAP), including celecoxib, are part of the World Health Organization s (WHO) analgesic ladder for the treatment of mild to moderate cancer pain. There are no celecoxib dosing guidelines for the treatment of somatic pain associated with cancer. 

The World Health Organization s (WHO) three-step analgesic ladder for cancer pain control recommends using acetaminophen alone for mild pain (step 1) and in combination with opioids for moderate pain (step 2). 

Barakzoy AS, Moss AH Efficacy of the world health organization analgesic ladder to treat... 

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