WHO Pain Ladder

Question 1

Step 1 on the pain ladder

Answer 1

Mild pain
Non opioid - paracetamol (1st line)
NSAID - ibuprofen

Question 2

Step 2

Answer 2

Moderate pain
Weak opioid - codeine, dihydrocodeine, tramadol
Can add non opioid analgesic

Question 3

Step 3

Answer 3

Severe pain
Strong opioid - morphine
Can add non opioid analgesic

Question 4

Additional considerations to make when prescribing

• non opioids
• weak opioids
• strong opioids

Answer 4

NSAID + PPI
Opioids + laxatives
Strong opioid + antiemetic
PO sustained release morphine + rescue doses of immediate release for breakthrough pain