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WHO analgesic
ladder revisited
M.R.Rajagopal MD
pallium.india@gmail.com
www.palliumindia.org
Advantages Advantages
! Simplicity ! Simplicity
But oversimplified?
! Applicability ! Applicability
! Safety ! Safety
! Emphasis on multi-
multi- ! Emphasis on multi-
multi-
modal analgesia modal analgesia
Advantages Advantages
! Simplicity ! Simplicity
But oversimplified? But oversimplified?
! Applicability ! Applicability
Are we sure?
! Emphasis on multi-
multi- ! Emphasis on multi-
multi-
modal analgesia modal analgesia
Advantages Simple?
WHY?
! Practically all NSAIDs (no response)
! Flavoxate (no response)
! Corticosteroids (no response)
! Intravesical local anesthetics (no response)
! Tramadol (no relief: very tired)
! IV Morphine + lorazepam
(no response; very drowsy)