WHO pain relief ladder in cancer palliation therapy

• WHO has developed a three-step "ladder" for cancer pain relief.
• If pain occurs, there should be prompt oral administration of drugs in the following order
• nonopioids (aspirin and paracetamol)
• then, as necessary, mild opioids (codeine)
• then strong opioids such as morphine, until 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.
• Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective.
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