The World Health Organization (WHO) uses an analgesic ladder to help guide pain management. While initially developed for management of cancer-related pain, it is applicable to other forms of pain as well.
Patient selection: patient experiencing pain
Level
Analgesic Regimen
1
non-opioid analgesic with or without adjuvant
2
opioid for mild-to-moderate pain with or without level 1 regimen
3
opioid for moderate to severe pain with or without level 1 regimen
where:
• Adjuvant agents include caffeine, tricyclic antidepressant, anticonvulsant or other drug that can enhance the analgesic effect.
Indications for progression to the next level of analgesia: pain that is persisting or increasing after an adequate trial at the current level.
The levels are meant to be a conceptual guideline. If a patient presents with pain which is unlikely to be handled at a given level of analgesia, then a higher level should be used.
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