Pain ladder

Pain ladder is a step-by-step approach developed by the World Health Organization (WHO) to manage pain in patients. It is a three-step "ladder" for managing pain in cancer, and it is applicable to any type of pain. The steps are as follows:

1. Non-opioids (aspirin and paracetamol)
2. Mild opioids (codeine)
3. Strong opioids such as morphine, which is the gold standard to which all newer analgesics are compared.

Overview

The World Health Organization (WHO) developed the Pain ladder to provide a simple and accessible method for the treatment of pain, particularly in cancer patients. The ladder was first introduced in 1986 and has since been adopted worldwide as a standard for medical professionals when treating pain.

Steps of the Pain Ladder

Step 1: Non-opioids

The first step of the pain ladder involves the use of non-opioid analgesics, such as aspirin and paracetamol. These medications are typically used for mild pain and have the advantage of being available over-the-counter without a prescription.

Step 2: Mild Opioids

If pain persists or increases, the next step involves the use of mild opioids, such as codeine. These are often used in combination with non-opioid analgesics to enhance pain relief.

Step 3: Strong Opioids

For severe pain, the third step of the ladder recommends the use of strong opioids, such as morphine. Morphine is considered the gold standard to which all newer analgesics are compared.

Application

The WHO pain ladder is a guideline and should be adapted to each individual patient's circumstances and response to pain. It is important to note that the ladder is not intended to be rigid, but rather to provide a framework for the treatment of pain.

See Also

• World Health Organization
• Aspirin
• Paracetamol
• Codeine
• Morphine