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J Pain Symptom Manage. 2005 Jan;29(1):41-54.

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

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Department of History, University of California at Los Angeles, Los Angeles, CA 90095-1473, USA.


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.

[Indexed for MEDLINE]

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