WHO Pain Ladder for Cancer Pain Relief in Adults

The WHO pain ladder is a framework for providing symptomatic pain relief in adults. 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

• Surgical intervention may provide further pain relief if drugs are not wholly effective.
• For the treatment of cancer pain in children, WHO recommends a two-step ladder; see WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses.

Adapted from: WHO Pain Relief Ladder for cancer pain relief in adults [accessed October 2015].