Definition
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
e. SCS/DCS
Similar Keywords: WHO ladder components
Subspecialty
Related Media
Keyword history
- 95%/2015
- 59%/2014
- 50%/2010
See Also:
Sources
PubMed
- 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
- 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