WHO Analgesic Ladder

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 07 January, 2011

Group 1

Patients with mild to moderate pain should take:

  • a non-opioid analgesic, such as paracetamol, or a non steroid anti-inflammatory drug (NSAD)
  • adjuvant drugs, if there is indication

Group 2

Patients with moderate to severe pain (or group 1 patients who have not achieved sufficient analgesia) should take:

  • an opioid commonly used in moderate pain (usually codein or tramadole)
  • a non-opioid analgesic, such as paracetamol, or a non steroid anti-inflammatory drug (NSAD)
  • adjuvant drugs, if there is indication

Group 3

Patients with severe pain (or group 2 patients who have not achieved sufficient analgesia) should take:

  • an opioid commonly used in severe pain, such as morphin, methadone, phentanyl

    a non-opioid analgesic, in some cases.

Adjuvant drugs

  • antidepressants
  • antiepileptics
  • local anaesthetics
  • clonidine
  • NMDA antagonists
  • corticosteroids