The "pain ladder" , or analgesic ladder , is created by the World Health Organization (WHO) as a guide for the use of drugs in pain management. Originally published in 1986 for the management of cancer pain, it is now widely used by medical professionals for the management of all kinds of pain.
The general principle is to start with a drug the first step, and then climb the ladder if the pain still exists. Drugs range from common, over-the-counter medicines on the lowest ladder, strong opioids.
Video Pain ladder
Staircase
The WHO guidelines recommend the rapid oral administration of oral medications ("by mouth") when pain occurs, if the patient is not severely ill, with non-opioid drugs such as paracetamol (acetaminophen) or aspirin, with or without "adjuvant" non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors. Then, if complete pain relief is not achieved or disease progression requires more aggressive treatment, weak opioids such as codeine, dihidrokodein or tramadol are added to existing non-opioid regimes. If this or is not enough, weak opioids are replaced by strong opioids, such as morphine, diamorphine, fentanyl, buprenorphine, oxymorphone, oxycodone or hydromorphone, while continuing non-opioid therapy, increasing opioid dose until the patient feels ill. free or maximum possible without unbearable side effects. If the initial presentation is severe pain, this stepping process must be bypassed and a strong opioid should be started in combination with a non-opioid analgesic.
The guideline directs that drugs should be given periodically ("by the hour") so that painkillers continue to occur, and ("by individuals") doses with the help of actual pain rather than fixed dosage guidelines. It acknowledges that breakthrough pain can occur and directs the immediate rescue dose administered.
The usefulness of the second step (weak opioids) is being debated in clinical and research communities. Some authors challenge the pharmacological validity of the step and, pointing to its higher toxicity and low efficacy, argue that weak opioids, with the possible exception of tramadol due to their unique actions, may be replaced with smaller doses of opioids.
Not all pain produces fully classical analgesics, and drugs that are not traditionally regarded as analgesics, but which reduce pain in some cases, such as steroids or bisphosphonates, may be used in conjunction with analgesics at any stage. Tricyclic antidepressants, class I antiarrhythmias, or anticonvulsants are the drug of choice for neuropathic pain. Up to 90 percent of cancer patients, immediately near death, use the adjuvant. Many adjuvants carry a significant risk of serious complications.
Maps Pain ladder
History
The ladder was developed by a team that included Jan Stjernswørd and Mark Swerdlow.
See also
- Opioid comparison, example of equianalgesic chart
- Pain management
References
Bibliography
External links
Source of the article : Wikipedia
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