Clinical application of the World Health Organization analgesic ladder.

One resource that has spurred the development of new standards for the assessment and treatment of pain is the World Health Organization (WHO) analgesic ladder, a three-step guide to the administration of analgesia and adjuvant medication for the treatment of pain. Correct application of the ladder is dependent upon knowledge of the interactions and side effects of the nonsteroidal anti-inflammatory drugs, opioids, and adjuvants recommended at each step of the ladder. Equianalgesic conversion can help provide correct dosing when changing opioids. Because of their altered metabolism and increased risk for epigastric complications, the elderly should receive special consideration when such medications are administered.