WHO Analgesic Ladder – can it be an escalator?

2012 June 30
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The pain team at Tata Cancer Hospital deserves congratulations on their several achievements – routine pain monitoring of postoperative patients and on their leadership in pain manangement activities.

On the 30th of July 2012, they started their two day pain education program under the leadership of Dr P.N.Jain, Dr Gehdoo and Dr Sumitra Bakshi. Pallium India was privileged to be part of this program.

“How rigid should be the ladder?” was a question that came up for discussion.

The group emphasized the need for flexibility in approach to the WHO analgesic ladder:

  • The concept should not prevent proper management of a patient with severe pain.
  • When someone is rolling in pain, it would be cruel to start him on step I of the ladder and gradually build the dose up over several days.
  • We may have to go straight to step III or resort to parenteral medication or interventions as appropriate.
  • “The ladder, when necessary, must become an escalator”, said Dr P.N. Jain.

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