WHO analgesic ladder


Step 1: Pain

a. Non-opioid

i. Paracetamol

ii. ASA

iii. NSAID

b. Adjuvant

i. steroids

ii. anxiolytics

iii. antidepressants

iv. hypnotics

v. anticonvulsants

vi. antiepileptic-like gabapentinoids (gabapentin and pregabalin)

vii. membrane stabilizers

viii. sodium channel blockers

ix. NMDA receptor antagonists for the treatment of neuropathic pain

x. cannabinoids

Step 2: Pain persisting or increasing:

a. Opioid for mild to moderate pain

i. Codeine

ii. Tramadol

iii. Propoxyphene

iv. Buprenorphine

v. Oxycodone (low dose)

b. Non-opioid

c. Adjuvant

Step 3: Pain persisting or increasing:

a. Opioid for moderate to severe pain

i. Morphine

ii. Fentanyl

iii. Methadone

iv. Hydromorphone

v. Oxycodone

b. Non-opioid

c. Adjuvant

Step 4: Interventional Therapy:

a. Nerve block

b. Epidural

c. PCA therapy

d. Neurolytic block therapy


Similar Keywords:  WHO ladder components


Related Media

Keyword history

  • 95%/2015
  • 59%/2014
  • 50%/2010

See Also:

Cancer pain — WHO ladder



  1. Daniel H Solomon, Jeremy A Rassen, Robert J Glynn, Joy Lee, Raisa Levin, Sebastian Schneeweiss The comparative safety of analgesics in older adults with arthritis. Arch. Intern. Med.: 2010, 170(22);1968-76
  2. Grisell Vargas-Schaffer Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician: 2010, 56(6);514-7, e202-5