Rationale:
The analgesic ladder was developed for cancer pain ("titrate to effect"). While it can be used for acute pain, it is unsuitable for long-term non-malignant pain.
References:
- KUPP - Kunnskapsbaserte oppdateringsvisitter. Riktigere bruk av opioider ved langvarige ikke-maligne smerter. Riktigere bruk av opioider ved langvarige ikke-maligne smerter - RELIS
- Ballantyne JC. Opioids for the treatment of chronic pain: mistakes made, lessons learned, and future directions. Anesth Analg 2017; 125(5):1769-78.