docPHONE MANUAL

THE MODERN ANALGESIC LADDER
STEP 1 : Non-opioid analgesics, NSAIDS,
STEP 2 : Weak opioids
STEP 3 : Strong Opioids
STEP 4 : Nerve blocks - epidurals, PCA pump, neurolytic block therapy, Spinal stimulators
Ref :
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-e205.

Non opioid anagesics are/NSAIDS :
Non-selective NSAIDs

Diclofenac
Diflunisal
Etodolac
Fenoprofen
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Mefenamic acid
Meloxicam
Nabumetone
Naproxen
Oxaprozin
Piroxicam
Sulindac
Tolmetin
COX-2 Selective NSAIDs
Celecoxib

WEAK OPIOIDS
Codeine
Tramadol

STRONG OPIOIDS
morphine
oxycodone
hydromorphone
buprenorphine
fentanyl
methadone - Methadone, in step 3, is important because it is currently very useful in the treatment of cancer pain, chronic noncancer pain, and refractory neuropathic pain that does not respond to conventional treatment.15,24,25 Methadone is also very useful in the rotation of opioids15,21–27 in cancer pain.
Adjuvants

NERVE BLOCKS
epidurals, PCA pump, neurolytic block therapy, Spinal stimulators

Adjuvants
steroids
anxiolytics,
antidepressants,
hypnotics,
anticonvulsants,
antiepileptic-like gabapentinoids (gabapentin and pregabalin),
membrane stabilizers,
sodium channel blockers, and
N-methyl-d-aspartate receptor antagonists for the treatment of neuropathic pain,
Cannabinoids