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Analgesic Ladder

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Analgesic Ladder
A venerated approach to managing a range of pain severity, formulated by the WHO for cancer; the ladder divides pain into
(1) mild—requiring NSAIDs and, if the pain is post-operative in nature, infiltration with local anaesthetics
(2) moderate—Step 1 plus opioid analgesics PRN
(3) severe—Step 1 and Step 2 plus local anesthetic neural blockade ±catheter plus sustained-release opioid analgesics
The stepwise approach to pain is valid for other types of pain—e.g., postoperative pain, sickle crisis pain, pelvic inflammatory disease


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Although the WHO analgesic ladder was originally designed with management of cancer pain in mind, it is widely used for non-malignant pain management.
Those remaining were treated for pain using the World Health Organization Analgesic ladder (J.
According to the analgesic ladder (Figure 1) paracetamol should first be tried: if ineffective, when taken as recommended, codeine should be added, and only after that (step 2) should NSAIDs be considered.
 
 
 
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