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WHO chronic pain ladder
1
Transcript
WHO chronic pain ladder
Step 1
MILD PAIN
Common side effects:
- Headaches
- Nausea
- stomach ulcer
- dizziness
- drowsiness
Mild pain:
- Non-opioid analgesics such as NSAIDs e.g ibuprofen
- used with or without adjuvents e.g gabapentin, diazepam
- can be prescribed at any point along ladder
Step 2:
MILD TO MODERATE PAIN
Possible side effects:
- Constipation
- Confusion and drowsiness
- Respiratory depression
- Dependance & tolerance
Mild to moderate pain:
- weak opioids e.g codeine, tramadol
- can be combined with non-opioid analgesics e.g co-codamol (codeine + paracetamol)
- with or without adjuvents
Step 3:
MODERATE TO SEVERE PAIN
Moderate to severe pain
- Minimal invasive action- recently added step due to opioid crisis
- e.gs- accupuncture, nerve block, disc decompression
Possible side effects:
- minimal side effects with most treatments
-accupuncture and nerve block may cause some bruising or bleeding
Step 4:
SEVERE TO VERY SEVERE PAIN
Possible side effects:
-similar to those caused by weak opioids, but more common and more pronounced
- since constipation and nausea are such common side effects, often prescribed with laxatives and anti-emetics
-common for people to become addicted
Severe to very severe pain
- potent opioids
- e.gs- morphine, fentanyl, oxycodone, methadone
- used with or without non-opioid analgesics and adjuvants
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