According to the WHO three-step analgesic ladder for cancer pain, which combination is the CORRECT step-2 recommendation for moderate cancer pain not controlled by step-1 drugs?
- A Aspirin alone in maximum doses
- B Strong opioids (morphine, oxycodone) at low dose
- C Neuromodulators (pregabalin, gabapentin) with antidepressants
- D Weak opioids (codeine, tramadol) ± non-opioid analgesics (paracetamol, NSAID) ✓
Explanation
The WHO analgesic ladder: Step 1 = non-opioids (paracetamol, NSAIDs) for mild pain; Step 2 = weak opioids (codeine, tramadol, low-dose oxycodone) ± non-opioids for moderate pain; Step 3 = strong opioids (morphine, oxycodone, fentanyl, hydromorphone) ± non-opioids for severe pain. Adjuvants (anticonvulsants, antidepressants, corticosteroids) can be added at any step for specific pain syndromes (neuropathic, bone, inflammatory). The key step-2 principle is adding a weak opioid to continue non-opioid therapy. Note: some guidelines now advocate a 2-step approach for cancer pain (skip step 2 in rapidly deteriorating patients).
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.