Oral and Dental Considerations in Pediatric Leukemic Patient

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.