{"id":2196,"date":"2018-07-03T12:22:26","date_gmt":"2018-07-03T12:22:26","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1129"},"modified":"2026-02-12T19:15:13","modified_gmt":"2026-02-12T19:15:13","slug":"who-pain-ladder","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/who-pain-ladder\/","title":{"rendered":"WHO Analgesic Ladder for Pain Management"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>WHO treatment guides for cancer pain provide explanations of the pathophysiology of such pain, how to make adequate assessments, how to choose analgesics, and how to use the ladder. Early studies on its effectiveness demonstrated that the method proposed by the WHO offered inexpensive treatment and adequate relief for 70% to 90% of cancer patients with pain.<!--more--><br \/>\nAdjuvant medications can be initiated as needed at any step of the ladder. These medications include antidepressants (e.g., tricyclics for acute neuropathic pain), anticonvulsants (e.g., gabapentin), and glucocorticoids (e.g., dexamethasone to reduce postoperative pain, nausea, and vomiting). The analgesic effectiveness increases with each step up on the ladder, as does the potential for medication abuse or addiction.<\/p>\n<p><strong>WHO Pain Ladder for Pain Management<\/strong><br \/>\nThe World Health Organization three-step analgesic ladder modified to exclude drugs unsafe in renal failure. Patients were treated with medications in step 1 when they rated their pain as a 1 to 4 on a 10-point scale. Patients were treated with medications in step 2 when they rated their pain as a 5 or 6 on a 10-point scale. Patients were treated with medications in step 3 when they rated their pain as a 7 to 10 on a 10-point scale.<br \/>\n<strong>Step 1<\/strong>, Mild Pain (1-4)<\/p>\n<ul>\n<li>Acetaminophen<\/li>\n<li>+\/- Adjuvants<\/li>\n<\/ul>\n<p><strong>Step 2<\/strong>, Moderate Pain (5-6)<\/p>\n<ul>\n<li>Hydrocodone<\/li>\n<li>Oxycodone<\/li>\n<li>Tramadol<\/li>\n<li>+\/- Analgesics nonopioids<\/li>\n<li>+\/- Adjuvants<\/li>\n<\/ul>\n<p><strong>Step 3<\/strong>, Severe Pain (7-10)<\/p>\n<ul>\n<li>Hydromorphone<\/li>\n<li>Methadone<\/li>\n<li>Fentanyl<\/li>\n<li>Oxycodone<\/li>\n<li>+\/- Analgesics nonopioids<\/li>\n<li>+\/- Adjuvants<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Carlson CL. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review.\u00a0J Pain Res. 2016 Jul 22;9:515-34. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27524918\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation.\u00a0JAMA. 1995 Dec 20;274(23):1870-3. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7500538\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>McGuire LS, Slavin K. Revisiting the WHO Analgesic Ladder for Surgical Management of Pain. AMA J Ethics. 2020 Aug 1;22(1):E695-701. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32880358\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jun 28, 2018.<br \/>\nUp-date Feb 12, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[425],"tags":[440,439,433,438,437,259,260,307,436,435,432,306],"class_list":["post-2196","post","type-post","status-publish","format-standard","hentry","category-anesthesiology","tag-analgesic","tag-analgesicos","tag-dolor","tag-escalera","tag-ladder","tag-management","tag-manejo","tag-oms","tag-opioides","tag-opioids","tag-pain","tag-who"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2196","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2196"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2196\/revisions"}],"predecessor-version":[{"id":10667,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2196\/revisions\/10667"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2196"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2196"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2196"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}