A validation study of the WHO analgesic ladder: A two-step vs three-step strategy

Marco Maltoni, Emanuela Scarpi, Caterina Modonesi, Alessandro Passardi, Sebastiano Calpona, Adriana Turriziani, Raffaella Speranza, Davide Tassinari, Pierantonio Magnani, Denis Saccani, Luigi Montanari, Britt Roudnas, Dino Amadori

Research output: Contribution to journalArticlepeer-review


Goals of work: The aims of the present study were to verify whether an innovative therapeutic strategy for the treatment of mild-moderate chronic cancer pain, passing directly from step I to step III of the WHO analgesic ladder, is more effective than the traditional three-step strategy and to evaluate the tolerability and therapeutic index in both strategies. Methods: Patients aged 18 years or older with multiple viscera or bone metastases or with locally advanced disease were randomized. Pain intensity was assessed using a 0-10 numerical rating scale based on four questions selected from the validated Italian version of the Brief Pain Inventory. Treatment-specific variables and other symptoms were recorded at baseline up to a maximum follow-up of 90 days per patient. Results: Fifty-four patients were randomized onto the study, and pain intensity was assessed over a period of 2,649 days. The innovative treatment presented a statistically significant advantage over the traditional strategy in terms of the percentage of days with worst pain ≥5 (22.8 vs 28.6%, p

Original languageEnglish
Pages (from-to)888-894
Number of pages7
JournalSupportive Care in Cancer
Issue number11
Publication statusPublished - Nov 2005


  • Analgesic ladder
  • Cancer pain
  • Opioids
  • Pain assessment
  • WHO guidelines

ASJC Scopus subject areas

  • Oncology
  • Nursing(all)


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