[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
March 20, 1996

Pain Control and the World Health Organization Analgesic Ladder

Author Affiliations

Oxford University Oxford, England
Royal Prince Alfred Hospital Camperdown, New South Wales, Australia

JAMA. 1996;275(11):835. doi:10.1001/jama.1996.03530350017013

To the Editor.  —Like many others, we welcome the increasingly systematic approach to therapeutic review articles. We wonder, however, whether there is need for a code of practice to govern the publication of systematic reviews. Thus, while we cannot argue with the presentation of data from eight studies in the article by Drs Jadad and Browman,1 we are disturbed by the tone and content of the commentary.In our opinion, the authors have made a fundamental error in calling for a randomized controlled trial of a concept (the WHO three-step analgesic ladder). Indeed, it has already been demonstrated in Canada that it is difficult to evaluate the broader concept of palliative care.1 Thus, to say that randomized controlled trials of the three-step analgesic ladder are necessary before we can say that it has improved the management of cancer pain is naive and irrelevant. In all areas of clinical