Analgesic ladder

WHO analgesic ladder

The WHO analgesic ladder for cancer pain is a schematic for providing symptomatic pain relief. Its three-step approach is relatively inexpensive and 80%-90% effective.1 Although developed for use in cancer pain, this stepwise approach to achieving adequate pain control may be adapted in the setting of chronic non-cancer pain.2

Right drug, right dose, right time interval

Analgesics should be administered1:

  • By mouth: Use the oral route wherever possible
  • By the clock: Administer analgesics at regular dosing intervals, not on demand
  • By the ladder: Treat with an appropriate analgesic, depending on the intensity of the pain, with dose titration to achieve optimal pain control with no, or tolerable, side effects, followed by sequential progress up the analgesic ladder



1. WHO Pain Relief Ladder for cancer pain relief. Available at: Accessed February 2012.
2. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 2010;56:514-517, e202-5.