In the management of chronic pain, the drug to be used as per first WHO ladder-step is:
Ans. b (Aspirin). (Ref Bailey & Love, 25th/pg. 65; 202)WHO LADDER FOR ANALGESIA: The main guide to the management of cancer pain is provided by the World Health Organization, which portrays three levels of treatment - the 'pain stepladder':First ring# Simple analgesics - aspirin, paracetamol, NSAIDs, tricyclic drugs or anticonvulsant drugs.Second ring# Intermediate strength opioids - codeine, tramadol or dextropropoxyphene;Third ring# Strong opioids-morphine(pethidine has been with- drawn from the second edition of the World Health Organization guide). Step 3. Severe Pain ||||||||MorphineOxymorphoneMethadoneLevarpheno!FentanylOxycodone+- Nonopioid analgesics+- Adjuvants Step 2. Moderate Pain |||||||Acet or ASA +CodeineHydrocodoneOxycodoneDthydrocodeineTramadol (not available with ASA or Acet)+ AdjuvantsStep 1. Mild PainAspirin (ASA)Acetaminophen (Acet)Nonsteroidal anti-inflammatory drugs (NSAIDs)+- Adjuvants"Adjuvants" refers either to medications that are coadministered to manage an adverse effect of an opioid or to so-called adjuvants analgesics that are added to enhance analgesia.
Morphine
Aspirin
Codine
Dextropropoxyphene
Miscellaneous