last updated 15-07-2024

Pain control

Pain control

Optimal analgesic treatment includes treating the patient until optimal pain relief is achieved, and when faced with chronic pain, preventing pain rather than rescuing the patient from it. The World Health Organisation (WHO) designed a scheme for the application of drugs in pain control. This scheme is called pain ladder or analgesic ladder.

Step 1

Non-opioids are the first step in pain control. These drugs (paracetamol, NSAIDs) are used in situations with mild pain. If the patient continues to experience pain while using the drugs of step 1, then the drugs of step 2 can tired or added.

Step 2

Step 2 covers weak opioids (such as codeine and tramadol).


Often these drugs are combined with drugs from step 1 as the opioids work on the transmission of pain and the non-opioids on the transduction of pain.

Step 3

When the pain persists after treatment with step 2 drugs, even stronger opioids (such as morphine) can be used to achieve pain control. In situations such as cancer pain, morphine is often utilised in combination with non-opioids or adjunct therapy.

Step 4

In the final step, potent opioids such as methadone, fentanyl, and oxycodone are applied. These drugs are mostly administered either parenterally or transdermally.



Patients with severe pain receiving drugs from the third step are mostly free from pain.


Some forms of pain can better be treated by other drugs than analgesics