Meeting the Challenges of Acute Pain Management: Medication Choices for Acute Pain

                    

                    Acute Pain Management

                                                

Medication choices for pain should reflect the reported intensity of the pain and any confounding factors, such as comorbidities and other medications being used concurrently, such as sedatives, sleeping pills, and antiemetics -- which can have a contributory sedating effect when used with opioids. The World Health Organization (WHO) Ladder is one of the best methods of selecting an appropriate medication on the basis of severity of the pain; this is a stepwise approach that can provide direction for prescribers when choosing a medication for the patient's pain intensity:
                                   

Step 1. Pain Intensity 1-3, Mild Pain

  • Acetaminophen -- daily limit, 4000 mg;
  • Nonsteroidal anti-inflammatory drugs (NSAIDs); both cyclooxygenase (COX)-2 (celecoxib); and nonselective NSAIDs, such as ibuprofen and ketorolac; and
  • Adjuvant medications, such as antidepressants, antiseizure medications, muscle relaxants, etc.

Step 2. Pain Intensity 4-6, Moderate Pain

  • Combination medications with codeine and acetaminophen, such as Tylenol#3;
  • Combination medications with hydrocodone and acetaminophen, such as Vicodin/Lortab);
  • Combination medications with oxycodone and acetaminophen/acetylsalicylic acid, such as Percocet/Percodan, or oxycodone alone, and as an extended-release formulation, Oxycontin;
  • Tramadol (Ultram) a mixed mu-agonist selective serotonin reuptake inhibitor medication that can be used as a short-acting medication or as an extended-release formulation (Ultram ER); and
  • Continue any adjuvant medication being used for added pain relief.

Step 3. Pain Intensity 7-10, Severe Pain

  • Morphine oral -- both short-acting morphine and extended-release MS Contin/intravenous (IV);
  • Hydromorphone (Dilaudid) used as oral or IV medication;
  • Fentanyl used as IV/subcutaneous (Duragesic) (not recommended for acute pain) or buccal Fentora or fentanyl oralets (only for use with opioid-tolerant patients);
  • Methadone (Dolophine), for experienced prescribers only on the basis of extended half-life and monitoring requirements; and
  • Continue adjuvant medications being used for added pain relief.
                                            

Comments

Post a Comment

Popular posts from this blog

Dandruff? There Are 5 Types, So You Might Just Be Treating It Wrong!

Image
Dandruff? There Are 5 Types, So You Might Just Be Treating It Wrong!                                                                It starts slowly. Your black clothes are the first to be banished. Then comes the embarrassment. The awkward dance of your hands with your hair – tucking it behind your ears, rolling it up in a bun, spreading it out strategically to conceal those pesky white flakes that lay beneath. Dandruff. And there are several types of dandruff. Read on. Diagnose Your Dandruff “Eczema, dryness of scalp, infrequent shampooing and a yeast-like fungus are all common causes of the itchiness and dry flakes that define dandruff. To treat this unfortunate condition, it’s best to identify the type of dandruff that may be getting you down,” explains Dr Gray. 1)Dry-skin related dandruff Dandruff caused by dry skin is one of the most common types and occurs mainly in winter, because washing hair with warm water tends to make the scalp dry and flaky. Interes
Read more
Image
Generalized Anxiety Disorder: Causes and Risk Factors                                           There is no singular cause of  generalized anxiety disorder  that has been identified. Evidence has shown that multiple factors are usually at play, influencing the development of GAD. Some of the common factors include things like genetic predisposition, brain chemistry, family background, social influence, and life experiences.                                Brain Structure The limbic system is a collection of brain structures that, among other functions, is involved in the regulation of many of our basic emotional reactions. Although it is generally under the control of the "thinking" part of our brain, it can respond to stimuli on its own as well. Genetics Your genetics may play a role in determining whether or not you will develop GAD. As with many other mental and medical health conditions, we can be genetically predisposed for dev
Read more