Table 1 Categorization of pain, appropriate analgesics, side effects, and co-medication
WHO analgesic ladder steps | Score 0/10 on NRS | Category of analgesic | Most important analgesic | Most important side effects | Co-medication |
|---|---|---|---|---|---|
1 (mild pain) | < 3 | Non-opioids | - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) | - gastrointestinal complications - heart attack - stroke - skin or allergic reactions | - Proton pump inhibitor - Antihistamines - Corticosteroids |
- Acetaminophen - Metamizole | - renal and liver toxicities - Hepatotoxicity - skin or allergic reactions | - Antihistamines - Corticosteroids | |||
2 (mild to moderate pain) | 3–6 | Weak opioids ± Non-opioids | - Tramadol - Tilidine + Naloxone | - Constipation - Nausea - Pruritus - motor and cognitive impairment - respiratory depression - sedation | - Laxatives - Anti-emetics - Corticosteroids - Antihistamines - Major tranquillizers - Psychostimulants |
3 (moderate to severe pain) | > 6 | Strong opioids ± Non-opioids | - Morphine - Hydromorphone - Oxycodone - Methadone - Levorphanol - Pethidine |