World Health Organization ladder

What is the World Health Organization ladder?

In the 1980s the World Health Organization (WHO) published guidelines for the control of pain in cancer patients.

These guidelines correlate intensity of pain to pharmacologic intervention: Mild pain (step 1) requires non-opioid analgesics with or without adjuvant medications. If the patient does not respond to treatment or the pain increases, the guideline suggests moving to step 2 by adding a mild opioid to the previous therapy. If the pain continues or increases in severity, then the clinician goes to step 3 and adds a strong opioid to the prior therapy. This algorithm has also been used in patients with non-cancer-related pain. It is unclear what its value is in clinical practice especially in developed countries.


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