Principles of Pain Management
The World Health Organization’s (WHO) Analgesic
Ladder for Cancer Pain Relief provides a stepwise
approach to managing pain in patients with cancer.19
The WHO analgesic ladder is simple to follow and
applicable to all pain, regardless of its etiology. Step 1
advises the use of paracetamol or a non-steroidal anti-
inflammatory
drug. If pain is not satisfactorily controlled,
it is appropriate to move to Step 2 Analgesia
which includes the use of weak opioids, usually codeine.
In practice, patients with severe pain usually need
Step 3 Analgesia, the use of strong opioids. Morphine
is the usual first-line Step 3 opioid however there are
many alternatives to morphine now.20 At any step, in the
analgesic ladder adjuvant analgesics can be used