We are independent & ad-supported. We may earn a commission for purchases made through our links.

Advertiser Disclosure

Our website is an independent, advertising-supported platform. We provide our content free of charge to our readers, and to keep it that way, we rely on revenue generated through advertisements and affiliate partnerships. This means that when you click on certain links on our site and make a purchase, we may earn a commission. Learn more.

How We Make Money

We sustain our operations through affiliate commissions and advertising. If you click on an affiliate link and make a purchase, we may receive a commission from the merchant at no additional cost to you. We also display advertisements on our website, which help generate revenue to support our work and keep our content free for readers. Our editorial team operates independently from our advertising and affiliate partnerships to ensure that our content remains unbiased and focused on providing you with the best information and recommendations based on thorough research and honest evaluations. To remain transparent, we’ve provided a list of our current affiliate partners here.

What Is the Analgesic Ladder?

Mary McMahon
Updated May 17, 2024
Our promise to you
WiseGEEK is dedicated to creating trustworthy, high-quality content that always prioritizes transparency, integrity, and inclusivity above all else. Our ensure that our content creation and review process includes rigorous fact-checking, evidence-based, and continual updates to ensure accuracy and reliability.

Our Promise to you

Founded in 2002, our company has been a trusted resource for readers seeking informative and engaging content. Our dedication to quality remains unwavering—and will never change. We follow a strict editorial policy, ensuring that our content is authored by highly qualified professionals and edited by subject matter experts. This guarantees that everything we publish is objective, accurate, and trustworthy.

Over the years, we've refined our approach to cover a wide range of topics, providing readers with reliable and practical advice to enhance their knowledge and skills. That's why millions of readers turn to us each year. Join us in celebrating the joy of learning, guided by standards you can trust.

Editorial Standards

At WiseGEEK, we are committed to creating content that you can trust. Our editorial process is designed to ensure that every piece of content we publish is accurate, reliable, and informative.

Our team of experienced writers and editors follows a strict set of guidelines to ensure the highest quality content. We conduct thorough research, fact-check all information, and rely on credible sources to back up our claims. Our content is reviewed by subject matter experts to ensure accuracy and clarity.

We believe in transparency and maintain editorial independence from our advertisers. Our team does not receive direct compensation from advertisers, allowing us to create unbiased content that prioritizes your interests.

The analgesic ladder is a concept developed by the World Health Organization (WHO) in the 1980s, initially for the management of cancer pain and later for handling all types of pain. Under this concept, doctors follow a stepped approach with pain management to reach the goal of eliminating pain with the lowest possible pain control. This can reduce the risk of side effects for the patient and also means that more aggressive pain control will be effective and available when needed because the patient has not developed a tolerance.

The first step in the analgesic ladder is the use of a non-opioid medication, possibly with an adjuvant. Drugs like aspirin fall into this category, while patients might also take medications to manage seizures, control depression, or handle other symptoms they experience. The addition of an adjuvant can mean that the patient avoids using pain control when she really needs a different medication.

If the patient still experiences pain, it is time to move to the next step, the use of a weak opioid with an adjuvant if appropriate. The patient might benefit from a pain management drug like codeine along with another medication to manage inflammation or other sources of discomfort. If pain levels continue at this stage, the patient reaches the top of the analgesic ladder, where a doctor can prescribe a strong opioid such as fentanyl along with an appropriate adjuvant.

Pain is a complicated condition to manage and there are a number of approaches to pain relief. Tools like the analgesic ladder create a clear set of criteria for managing pain to make it easier for doctors to determine what the next stage should be. At each step, a doctor can make decisions like adjusting dosages, trying different medications, or exploring additional adjuvants to see if these will bring the patient's pain under control. Treatments like psychotherapy or electrical nerve stimulation for pain, for example, may be more beneficial for a patient than ramping up analgesic dosages.

Patients with chronic pain conditions can be difficult to treat accurately and effectively, even with the analgesic ladder. With many opioids, there is the concern of acquiring resistance over time. The patient will need increasingly high doses of medication to control pain, and may eventually find a pain management technique ineffective. A pain specialist may be able to offer the best treatment, in contrast with a general practitioner or a doctor who focuses on another area of medical care like rheumatology.

WiseGEEK is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a WiseGEEK researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments

Mary McMahon

Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

Read more
WiseGEEK, in your inbox

Our latest articles, guides, and more, delivered daily.

WiseGEEK, in your inbox

Our latest articles, guides, and more, delivered daily.