World Health Organization (WHO) pain ladder

Management

• Step 1 (mild pain)
  • aspirin 650 mg PO
  • tylenol 650 mg PO
  • NSAIDs
    • ibuprofen 200-800 mg PO
    • naproxen 250-275 mg PO
    • indomethacin 25-75 mg PO
    • piroxicam 10-20 mg PO
• Step 2 (moderate pain)
  • acetaminophen combinations
    • tylenol#3, tylenol#4
    • Vicodin, Lorcet
    • Percocet, Endocet
  • codeine
  • hydrododone
  • morphine IR, 15-30 mg PO, 1-10 mg/hr IV, 4-15 mg SQ
• Step 3 (severe pain)
  • morphine (sustained release) 15-30 mg PO
  • oxycodone (immediate-release) 10 mg PO
  • OxyContin (sustained-release 10-20 mg PO
  • hydromorphone (Dilaudid) 4-8 mg PO, 1-2 mg IV
  • methadone 5-10 mg PO, 2.5 mg IV
  • Levorphanol 2-4 mg PO
  • Fentanyl 25 mg PO, transdermal patch 25 ug/hour

Doses are guidelines & must be individualized

More general terms

• clinical practice guideline (CPG)

Additional terms

• pain management in palliative care