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



Analgesic Regimen


non-opioid analgesic with or without adjuvant


opioid for mild-to-moderate pain with or without level 1 regimen


opioid for moderate to severe pain with or without level 1 regimen



• 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.

To read more or access our algorithms and calculators, please log in or register.