WHO Pain Ladder for Cancer Pain Relief

Summary of three-step approach to analgesia in cancer patients. The WHO pain ladder is a framework for providing symptomatic pain relief. The three-step approach is inexpensive and 80-90% effective.

By mouth
The oral route is preferred for all steps of the pain ladder

By the clock
Cancer pain is continuous – analgesics should be given at regular intervals (every 3-6 hours), not on demand

Adjuvants
To help calm fears and anxiety, adjuvant analgesics may be added at any step of the ladder

The ladder has no 'top rung' as there is no maximum dose for strong opioids.
If pain is still a problem with high doses of morphine (e.g. greater than 300mg every 24 hours), or if there are severe side effects, reconsider the cause of pain (e.g. bone pain may be better helped by NSAIDs) and/or seek specialist advice.

Reference
WHO Pain Relief Ladder for cancer pain relief – available at www.who.int