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Pain relief ladder

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1. WHO’s pain ladder

The World Health Organization has developed a three-step ladder for cancer pain relief.

On the WHO website they write:

“If a pain occurs, there should be a prompt oral administration of drugs in the following order: non-opioids (aspirin or paracetamol); then, as necessary, mild opioids (codeine); or the strong opioids such as morphine, untill the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used.  To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand”. This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective…….” 

Pain relief ladder

This is a message that is easy to deliver and easy to understand, but since it was introduced in 1986 there has been a major development in the field of palliative medicine and thus some of the recommendations have been modified:

  • Pain relief should be provided to all seriously ill and dying patients, not only cancer patients.
  • the middle step of the ladder using mild opioids is often skipped in  seriously ill and dying patients as their pain is so severe that strong opioids are needed.
  • Adjuvant drugs should also be used to treat neuropathic pain and other specific pain conditions.  

2.’s pain ladder for Musculoskeletal Pain relief

We suggest a new pain ladder for musculoskeletal pain relief:

Pain relief ladder

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