scholarly journals The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain?

2020 ◽  
Vol Volume 13 ◽  
pp. 411-417 ◽  
Author(s):  
Juan Yang ◽  
Brent A Bauer ◽  
Dietlind L Wahner-Roedler ◽  
Tony Y. Chon ◽  
Lizu Xiao
Keyword(s):  
Cancer Pain ◽  
Who Analgesic Ladder ◽  
Analgesic Ladder

scholarly journals Independent Research on Cancer Pain Management in the Setting of Early Palliative Care: A Flywheel to Counteract General Opioid Misuse and Abuse

2020 ◽  
Vol 17 (19) ◽  
pp. 7097
Author(s):  
Elena Bandieri ◽  
Leonardo Potenza ◽  
Fabio Efficace ◽  
Eduardo Bruera ◽  
Mario Luppi
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
World Health ◽  
Evidence Based ◽  
Cancer Pain Management ◽  
Who Analgesic Ladder ◽  
Early Palliative Care ◽  
Positive Effects ◽  
Analgesic Ladder

The increased recognition of the high prevalence and important burden of cancer pain and the documentation of a large proportion of patients receiving inadequate analgesic treatment should have reinforced the need for evidence-based recommendations. The World health Organization (WHO) guidelines on cancer pain management—or palliative care—are traditionally based on a sequential, three-step, analgesic ladder according to pain intensity: nonopioids (paracetamol or nonsteroidal anti-inflammatory drugs) to mild pain in step I; weak opioids (eg, codeine or tramadol) to mild-moderate pain in step II; and strong opioids to moderate-severe pain in step. III. Despite the widespread use of this ladder, unrelieved pain continues to be a substantial concern in one third of patients with either solid or hematologic malignancies. The sequential WHO analgesic ladder, and in particular, the usefulness of step II opioids have been questioned but there are no universally used guidelines for the treatment of pain in patients with advanced cancer and not all guideline recommendations are evidence-based. The American Society of Clinical Oncology and the European Society of Medical Oncology have recommended the implementation of early palliative care (EPC), which is a novel model of care, consisting of delivering dedicated palliative service concurrent with active treatment as early as possible in the cancer disease trajectory. Improvement in cancer pain management is one of the several important positive effects following EPC interventions. Independent well-designed research studies on pharmacological interventions on cancer pain, especially in the EPC setting are warranted and may contribute to spur research initiatives to investigate the poorly addressed issues of pain management in non cancer patients.

Management of Neuropathic Cancer Pain Following WHO Analgesic Ladder: A Prospective Study

2008 ◽  
Vol 25 (6) ◽  
pp. 447-451 ◽  
Author(s):  
Seema Mishra ◽  
Sushma Bhatnagar ◽  
Deepak Gupta ◽  
Gaurav Nirwani Goyal ◽  
Roopesh Jain ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Prospective Study ◽  
Who Analgesic Ladder ◽  
Analgesic Ladder ◽  
A Prospective Study

The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it?

2006 ◽  
Vol 14 (11) ◽  
pp. 1086-1093 ◽  
Author(s):  
Karine Azevedo São Leão Ferreira ◽  
Miako Kimura ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Pain Control ◽  
Who Analgesic Ladder ◽  
Analgesic Ladder

Management of lung cancer-related pain

2011 ◽  
Vol 152 (30) ◽  
pp. 1184-1191 ◽  
Author(s):  
Károly Tagányi
Keyword(s):  
Lung Cancer ◽  
Surgical Therapy ◽  
Interventional Procedures ◽  
Advanced Lung Cancer ◽  
Moderate Pain ◽  
Who Analgesic Ladder ◽  
Mild Pain ◽  
Analgesic Ladder ◽  
Inflammatory Drugs ◽  
Strong Opioids

Pain occurs in seventy-four percent of patients suffering from advanced lung cancer, and eighty-two percent of patients feels that the applied treatment of pain was inefficient. The management of cancer-related pain is based on the WHO analgesic ladder. The ladder has three steps. Step one involves the use of nonsteroidal anti-inflammatory drugs for mild pain, step two mild opioids for moderate pain and step three strong opioids for the treatment of heavy pain. This management – in case of emergency – is supplemented by interventional procedures (nerve blockades, surgery). The most effective pain-killing intervention is the all-round oncological and surgical therapy. The different treatments (oncological, radiological, surgical, drug and interventional) are applied in combination with each other. The paper is dealt with the possibility offered by the drug and interventional treatments. Orv. Hetil., 2011, 152, 1184–1191.

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