Pain relief ladder for cancer pain

If you have pain related to cancer, your doctor will recommend different pain relievers (analgesics) depending on the nature of your pain, what’s causing it, and how severe it is.

The World Health Organization (WHO) developed guidelines for cancer pain relief in 1986. These guidelines outline a pain relief ‘ladder’.

who analgesic ladder

Doctors often use this 3-step approach when prescribing pain-relief medicines for people with cancer. Pain-relief medicines such as paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first for mild pain. If pain persists or gets worse, opioids (such as codeine or morphine) are used, either alone or in combination with the non-opioid medications. Occasionally additional medicines (adjuvants) are used with these analgesics; these can help the pain killers work more effectively.

Last Reviewed: 14 October 2015

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1. World Health Organization. Cancer. WHO's cancer pain ladder for adults. Available from: (accessed Oct 2015).


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