Table 4.

WHO analgesic ladder for the 3 stepwise treatments to relieve pain in mucositis [13].

Step  1	Nonopioid* ± adjuvant†	Pain persisting or increasing. Step up
Step  2	Opioid for mild to moderate. Pain ± nonopioid ± adjuvant	Pain persisting or increasing. Step up
Step  3	Opioid for moderate to severe pain§ ± nonopioid ± adjuvant

*Aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs.

^†Amitriptyline, carbamazepine, and gabapentin for neuropathic pain; prednisone or dexamethasone for pain associated with intracranial pressure, nerve, and spinal cord compression.

^‡Codeine, hydrocodone, and tramadol.

^§Morphine, fentanyl, and hydromorphone.