1. WHO’s pain ladder
The World Health Organization has developed a three-step ladder for cancer pain relief.
On the WHO website they write:
“If a pain occurs, there should be a prompt oral administration of drugs in the following order: non-opioids (aspirin or paracetamol); then, as necessary, mild opioids (codeine); or the strong opioids such as morphine, untill the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand”. This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective…….”
This is a message that is easy to deliver and easy to understand, but since it was introduced in 1986 there has been a major development in the field of palliative medicine and thus some of the recommendations have been modified:
- Pain relief should be provided to all seriously ill and dying patients, not only cancer patients.
- the middle step of the ladder using mild opioids is often skipped in seriously ill and dying patients as their pain is so severe that strong opioids are needed.
- Adjuvant drugs should also be used to treat neuropathic pain and other specific pain conditions.
2. Dieutridau.com’s pain ladder for Musculoskeletal Pain relief