ArticleJournal of pain research2020
The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain?
Article in Journal of pain research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
79 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat cancer pain.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Pooled it
- Allogenic bone marrow-derived mesenchymal stromal cell-based therapy for patients with chronic low back pain: a prospective, multicentre, randomised placebo controlled trial (RESPINE study).Annals of the rheumatic diseases · 2024Trial
- Transcutaneous electrical acupoint stimulation for cancer-related pain management in patients receiving chronic opioid therapy: a randomized clinical trial.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023Trial
- Practice patterns of strong opioid recommendations by palliative care consultation services in German hospitals (online survey).BMC palliative care · 2026Article
- [Percutaneous therapy for back pain : Epidural and perifacet therapies].Radiologie (Heidelberg, Germany) · 2026Review
- Peripheral Nerve Stimulation for Perioperative Care in Oncologic Surgical Cases: A Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- Clinical Efficacy and Risks of Clonidine Infusion for Sedation and Analgesia: A Narrative Review.Current pain and headache reports · 2026Review
- Analgesic Utilization Pattern and Cost of Managing Children with Sickle Cell Diseases: a Retrospective Single-site Audit.Journal of racial and ethnic health disparities · 2026Article
- A Service Evaluation of Heisei Shiatsu Massage as an Adjunct to the Pharmacological Management of Cancer Pain.International journal of therapeutic massage & bodywork · 2026Article
- Pain prevalence and pain management at the end of life: regional and urban-rural differences from a national-representative survey of Chinese older adults.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026Article
- Acute pain and analgesic prescribing in trauma inpatients at a tertiary hospital: A cross-sectional study.Journal of the colleges of medicine of South Africa · 2026Article
- Comparative analysis of pain management protocols in pediatric and adult emergency medicine: a narrative review.Frontiers in public health · 2026Review
- Analgesic efficacy of oral tramadol-dipyrone combination in cats undergoing ovariohysterectomy.Frontiers in veterinary science · 2026Article
- Psychiatric, Cardiovascular and Skeletal Risks of Codeine versus Oxycodone in Hip Osteoarthritis: A Population-Based Cohort Study.Drug design, development and therapy · 2026Article
- Inclusion of "palliative care pharmacology" as a new chapter in the pharmacology textbook for medical undergraduate students: A strength, weakness, opportunity, and threat analysis.Indian journal of pharmacology · 2026Article
- Pain management in chronic limb-threatening ischaemia: a multi-centre cross-sectional study.Frontiers in medicine · 2026Article
- The Role of Clinical Pharmacogenetics and Opioid Interactions in Pain Management: Current Evidence and Future Perspectives.Pharmaceutics · 2026Review
- Episodic Memory, Chiari I Malformation, Personality and Coping: The Role of Chronic Pain.Behavioral sciences (Basel, Switzerland) · 2025Review
- Opioid dependence in patients with pain in chronic pancreatitis an emerging problem.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2025Review
- A Chrono-Prolific Controlled Release Tripartite Tablet: Case Study of Paracetamol, Diclofenac Sodium and Esomeprazole Magnesium Trihydrate.AAPS PharmSciTech · 2025Article
19 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionFrom 1986, the World Health Organization (WHO) analgesic ladder has been used as the simple and valuable pain-relieving guidance in the pharmaceutical pain management, however, with the development of medical history, notions about pain physiology and pain management have already updated. Is the analgesic ladder still appropriate for chronic non-cancer pain (CNCP) patients? This study aims to analyse the current usage of the analgesic ladder in patients with CNCP by evaluating previously published pertinent studies.
methodsLiterature published in English from January 1980 to April 2019 and cited on PubMed database was included. Analysis on the analgesic ladder, current status of CNCP management, and a new revised ladder model were developed based on relevant literature.
resultsThe WHO analgesic ladder for cancer pain is not appropriate for current CNCP management. It is revised into a four-step ladder: the integrative therapies being adopted at each step for reducing or even stopping the use of opioid analgesics; interventional therapies being considered as step 3 before upgrading to strong opioids if non-opioids and weak opioids failed in CNCP management. DISCUSSION: A simple and valuable guideline in past years, the WHO analgesic ladder is inappropriate for the current use of CNCP control. A revised four-step analgesic ladder aligned with integrative medicine principles and minimally invasive interventions is recommended for control of CNCP.
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