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.

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

MIMS Clinics

Prescribing news and resources for key therapeutic areas, collated by the MIMS editors.

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS bulletins

News and updates straight to your inbox.

Prescribing Update: Fortnightly news bulletin
Spotlight: Disease-themed monthly round-up

Sign me up

MIMS Dermatology

Read the latest issue online exclusively on MIMS.

Read MIMS Dermatology

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases

Promo Image

Clinical calculators

Handy calculators and conversions for primary care.