The ladder and the clock: cancer pain and public policy at the end of the twentieth century

J Pain Symptom Manage. 2005 Jan;29(1):41-54. doi: 10.1016/j.jpainsymman.2004.08.004.


The origins of the WHO Cancer Pain Relief Program (the Analgesic Ladder) and its research basis in two very different research traditions, one at Memorial Sloan-Kettering Cancer Center in New York, the other at St. Christopher's Hospice in London, are discussed. The Sloan-Kettering group emphasized precise relative differences in analgesic effects of various drugs, whereas Twycross at St. Christopher's used patient well-being as the crucial benchmark. Despite these differences, both traditions presented evidence of the safe and effective use of strong opioids for cancer pain relief, in a setting of individualized attention and close physician monitoring. The success and limitations of the Ladder as a global health policy are briefly addressed.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesia / history*
  • History, 20th Century
  • Hospices / history*
  • Humans
  • London
  • Neoplasms / history*
  • New York
  • Pain / drug therapy
  • Pain / history*
  • Public Policy