Feasibility of using World Health Organization (WHO) pain ladder in the management of pain at a secondary healthcare center

Abstract

The objectives of this report were to determine the feasibility of adhering to World Health Organization 
(WHO) three-step pain management guidelines in a secondary healthcare institution and to identify 
areas where improvements are needed. The study was carried out in January, 2012. Descriptive 
analysis of available analgesics and adjuvants was done and the cost implications were also evaluated. 
Analgesic options for the 3 rungs of the WHO pain ladder were available. However, 11/14 (78.6%) of all 
the analgesics were nonsteroidal antiinflammatory drugs (NSAIDS). No Cox-2 inhibitor was available. 
Tramadol and Dihydrocodeine were the only agents available for second level treatment of pain, while 
parenteral pentazocine was the only agent available for the treatment of severe pain. All the agents 
were affordable. Managing pain using the WHO pain ladder is feasible at secondary healthcare 
hospitals. However, there is a need to expand analgesic options at the second and third rungs of the 
ladder.