WHO's cancer pain ladder for adults

WHO has developed a three-step "ladder" for cancer pain relief in adults.

If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. 

To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective. In the case of cancer pain in children, WHO recommends a two step ladder.

For further information see WHO Guidelines on the pharmacological treatment of persisting pain in children with medical illnesses at: