Pain ladder

The pain ladder is a term originally coined by the World Health Organisation (WHO) to describe a method of controlling pain [ [http://www.who.int/cancer/palliative/painladder/en/ WHO | WHO's pain ladder ] ] . It was originally described for the management of cancer pain, but is now widely used as a general principle for pain management for all types of pain by medical professionals.

The general principle in pain management is to start at the bottom rung of the ladder, and then to climb the ladder if pain is still present. The medications range from household, over the counter drugs with minimal side-effects at the lowest rung to powerful opioids. Opioid usage carries a high risk of addiction and adverse effects if abused.

The Ladder

Bottom rung of ladder (mild pain): Non opioid +/- adjuvant
Next rung of ladder (worse pain): Weaker opioid +/- non opioid +/- adjuvant
Highest rung of ladder (worst pain): Strong opioid +/- non opioid +/- adjuvant

Definitions

1. Non opioid: aspirin, paracetamol (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or ibuprofen
2. Weaker opioid: tramadol, codeine, dihydrocodeine
3. Strong opioid: morphine, diamorphine (heroin), fentanyl, buprenorphine, oxycodone, hydromorphone
4. Adjuvant: antidepressants, anticonvulsants, steroids, muscle relaxants, exercise, psychological support, temperature therapy, primal therapy, hydrotherapy, acupuncture

References

External Links

* [http://www.who.int/cancer/palliative/painladder/en/ Pain Ladder at the WHO]