WHO Pain Ladder: A Stepwise Approach to Pain Management

The World Health Organization (WHO) Pain Ladder is a globally recognized framework for the systematic management of pain, particularly in palliative care and oncology settings. Introduced in 1986, it offers a three-step approach that aligns the intensity of analgesic therapy with the severity of the patient's pain. This simple yet effective strategy has since become a cornerstone of pain relief protocols worldwide.

Step 1 involves the use of non-opioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain.
Step 2 recommends the addition of weak opioids like codeine or tramadol when pain persists or increases.
Step 3 addresses severe pain through the use of strong opioids such as morphine, often in combination with non-opioids and adjuvant therapies to enhance efficacy and manage associated symptoms (Suh et al., 2011; Coluzzi et al., 2016).

Step	Type of Pain	Treatment Approach	Example Medicines
1️⃣	Mild Pain	✅ Non-opioid ± Adjuvant	- Paracetamol (acetaminophen) - Ibuprofen (NSAIDs)
2️⃣	Moderate Pain	✅ Weak opioid + Non-opioid ± Adjuvant	- Codeine - Tramadol + Paracetamol
3️⃣	Severe Pain	✅ Strong opioid ± Non-opioid ± Adjuvant	- Morphine - Fentanyl - Oxycodone

A robust body of evidence supports the clinical effectiveness of this ladder....

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