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WHO analgesic ladder

WHO analgesic
ladder
Definition
Step 1: Pain

a. Non-opioid

i. Paracetamol

ii. ASA

iii. NSAID

b. Adjuvant

i. steroids

ii. anxiolytics

iii. antidepressants

iv. hypnotics

v. anticonvulsants

vi. antiepileptic-like
gabapentinoids
(gabapentin and
pregabalin)

vii. membrane stabilizers

viii. sodium channel

blockers

ix. NMDA receptor

antagonists for the
treatment of neuropathic
pain

x. cannabinoids

Step 2: Pain persisting or increasing:

a. Opioid for mild to moderate

pain

i. Codeine

ii. Tramadol

iii. Propoxyphene

iv. Buprenorphine

v. Oxycodone (low dose)

b. Non-opioid

c. Adjuvant

Step 3: Pain persisting or increasing:

a. Opioid for moderate to

severe pain

i. Morphine

ii. Fentanyl

iii. Methadone

iv. Hydromorphone

v. Oxycodone

b. Non-opioid

c. Adjuvant

Step 4: Interventional Therapy:

a. Nerve block

b. Epidural

c. PCA therapy

d. Neurolytic block therapy

e. SCS/DCS

Similar Keywords: WHO ladder

components

Subspecialty
Pain and Regional Anesthesia
Related Media
Keyword history
95%/2015
59%/2014
50%/2010

See Also:
Cancer pain — WHO ladder

Sources
1. Analgesic

PubMed
1. Daniel H Solomon, Jeremy A
Rassen, Robert J Glynn, Joy
Lee, Raisa Levin, Sebastian
Schneeweiss The
comparative safety of
analgesics in older adults
with arthritis. Arch. Intern.
Med.: 2010, 170(22);1968-
76
2. Grisell Vargas-Schaffer Is
the WHO analgesic ladder
still valid? Twenty-four years
of experience. Can Fam
Physician: 2010, 56(6);514-
7, e202-5

Filed Under: ABA Keyword Categories,

Advanced, Pain, Subspecialty: Pain and
Regional Anesthesia, W

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