Chronic Pain Management: WHO Three-step Ladder ApproachCreated by:
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The World Health Organization has released a three-step ladder approach to cancer pain in 1986. As the practice of medicine has elvolved three decades after the initial release, it is now used not only for cancer pain but also for chronic pain to other chronic illnesses. The stepladder approach is a good guide to ensure that the patient gets sufficient analgesia, especially in the emergency room setting. A doctor must always ask the pain intensity using the pain scale (1-10) in order to be guided with this approach. Here are the segments of the three-step ladder analgesia recommendation:
Step 1 ( for Mild pain with 1-3 intensity) - use Acetaminophen q6 and NSAIDs BID to TID plus an adjuvant (such as muscle relaxant [ for spasms] or anticonvulsant [for radiculopathy] )
Step 2 ( for Moderate pain with 4-6 intensity) - use a weak opiod q6 - q8 plus medications in step 1
Step 3 ( for Severe pain with intensity of 7 and above) - repalce weak opioid with a stronger opioid plus medications in step 1 given round the clock
This has been really helpful in pain management for our practice. Are you using the same guidelines for pain management in your practice? Do you find the three-step ladder approach effective for chronic pain cases?