CHOOSING ANALGESICS
WHO 3-STEP LADDER When first starting an analgesic, choose one based on the severity of the patient’s pain. Within a step, choose the analgesics most appropriate for each patient:
3 Severe (7-10) Morphine Oxycodone Hydromorphone Fentanyl
Start at Step
2 Moderate (4-6) Codeine Tramadol A / Codeine A / Hydrocodone A / Oxycodone ± Adjuvants ( Meperidine / pethidine
Severity
1‒3
1
Methadone ± Adjuvants
4‒6
2
1 Mild (1-3) A cetaminophen / Paracetamol ASA / NSAIDs ± Adjuvants ( Propoxyphene notindicated )
7‒10
3
& pentazocine notindicated )
A = Acetaminophen / paracetamol ASA = Acetylsalicylic Acid NSAID = Non-steroidal anti-inflammatory
10 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
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