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A modern analgesics pain 'pyramid'
1Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA.
Journal of Clinical Pharmacy and Therapeutics
|January 4, 2014
Summary
The World Health Organization (WHO) analgesic ladder, a stepwise pain management approach, needs updating due to evolving pain science and new treatments. A modern analgesic pyramid is proposed for better pain relief.
Area of Science:
- Pain Management
- Pharmacology
- Evidence-Based Medicine
Background:
- The World Health Organization (WHO) established an analgesic ladder in 1986 for stepwise pain management.
- This approach guided the use of non-opioid, weak opioid, and strong opioid analgesics.
- Concerns regarding strong opioid use influenced the WHO's conservative stepwise strategy.
Purpose of the Study:
- To re-evaluate the WHO analgesic ladder in light of current pain management understanding.
- To propose a more contemporary model for analgesic pharmacotherapy.
- To address advancements in pain physiology and available analgesic options.
Main Methods:
- Review of the historical context and principles of the WHO analgesic ladder.
- Analysis of changes in pain science and treatment modalities since 1986.
- Conceptual development of an alternative pain management framework.
Main Results:
- The original WHO analgesic ladder provided a framework for opioid use justification.
- Significant advancements in understanding pain as a physiological process have occurred.
- A wider array of analgesic options is now available.
Conclusions:
- The WHO analgesic ladder requires modernization due to evolving pain management paradigms.
- An updated analgesic pyramid model is suggested as a more current best practice.
- This reflects a better understanding of pain physiology and improved therapeutic options.
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