WHO Pain Ladder for Cancer Pain Relief in Adults

Summary of 3-step approach to analgesia in cancer patients.

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 .

Adapted from:  [accessed October 2015].


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