WHO Ladder Tramadol Step — FRCA Final MCQ
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Correct answer: D — Step 2 — weak opioid
WHO ladder: Step 1 = non-opioid (paracetamol, NSAIDs), Step 2 = weak opioid ± non-opioid (codeine, tramadol, dihydrocodeine), Step 3 = strong opioid ± non-opioid (morphine, oxycodone, fentanyl). Tramadol is a weak opioid (Step 2). Note: WHO now questions the utility of Step 2 — direct titration to low-dose strong opioids may be more effective.
Reference: WHO – 2019 – WHO analgesic ladder (revised); FPM – 2023