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Pain Control and the World Health Organization Analgesic Ladder

Vittorio Ventafridda, MD, PhD; Jan Stjernsward, MD, PhD, FRCP
JAMA. 1996;275(11):835-836. doi:10.1001/jama.1996.03530350017014.
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To the Editor.  —We would like to congratulate you on the attention devoted by JAMA on the treatment of cancer pain, a much neglected topic. But we cannot fail to be somewhat concerned by the article by Drs Jadad and Browman1 regarding the WHO analgesic ladder for cancer pain control. We do not need a meta-analysis of randomized controlled studies to know whether aspirin and morphine are effective against pain. Common sense is not always common, obviously. Furthermore, everything measurable is not necessarily relevant.Moreover, in their article, Jadad and Browman do not give enough consideration to the fact that these analgesic guidelines have also been produced to disseminate important therapeutic and caring principles, indispensable for correct treatment of cancer pain, in both developed and developing countries.2 Thanks to the principles of the WHO analgesic ladder for cancer pain and the development of concordant policies, education of the


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