Pain pp 949-951 | Cite as

Analgesic Ladder Approach

  • Graham R. Hadley
  • Mark R. Jones
  • Alan David KayeEmail author


The cancer analgesic ladder was developed by the World Health Organization (WHO) in 1986 and ratified in 1996 to guide clinicians treating cancer pain. Initially created for resource-poor countries, the cancer analgesic ladder remains a cornerstone of modern pain medicine. The easy to navigate, four-step approach begins with the use of NSAIDs and acetaminophen, progresses to the use of opioid analgesics, and eventually leads to surgical intervention.


Cancer analgesic ladder WHO pain relief ladder Management of chronic pain 


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    World Health Organization. Cancer pain relief. 2nd ed. Geneva: World Health Organization; 1996.Google Scholar
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    Jost L, Roila F, ESMO Guidelines Working Group. Management of cancer pain: ESMO clinical recommendations. Ann Oncol. 2008;19(Suppl 2):ii119–21.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Graham R. Hadley
    • 1
  • Mark R. Jones
    • 2
  • Alan David Kaye
    • 3
    Email author
  1. 1.Department of Anesthesiology, Perioperative Care and Pain MedicineNew York UniversityNew YorkUSA
  2. 2.Department of AnesthesiologyBeth Israel Deaconess Medical CenterBostonUSA
  3. 3.Department of AnesthesiaLSUHSCNew OrleansUSA

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