Analgesic

Aka: Analgesic, Pain Medication, Anodyne

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II. Preparations: Non-Opioid Analgesics

  1. Acetaminophen
  2. Nonsteroidal Anti-inflammatory (NSAID)
    1. See NSAID Gastrointestinal Adverse Effects
    2. See NSAID Renal Adverse Effects
    3. COX2 Selective NSAID (e.g. Celecoxib)
    4. Acetic Acid NSAID
      1. Partial cox2-selective (e.g. Etodolac, Nabumetone)
      2. Indoles (e.g. Indomethacin, Sulindac)
      3. Pyrrolo-pyrroles - ParenteralNSAIDs (e.g. Ketorolac)
    5. Fenamate NSAID
      1. Anthranilic Acid (e.g. Meclofenamate)
      2. Acetic Acid (e.g. Diclofenac)
    6. Oxicam NSAID (e.g. Meloxicam, Piroxicam)
    7. Propionic Acid NSAID (e.g. Ibuprofen, Naproxen )
    8. Salicylates (e.g. Aspirin)
  3. Topical Analgesic
    1. Topical NSAID (Diclofenac)
    2. Lidocaine Patch (Lidoderm)
    3. Capsaicin
  4. Corticosteroid
    1. High potency, high antiinflammatory and long acting agents
      1. Betamethasone
      2. Dexamethasone
    2. Moderate potency, moderate antiinflammatory and medium duration agents
      1. Methylprednisolone
      2. Triamcinolone
      3. Prednisolone
      4. Prednisone
    3. Low potency, low antiinflammatory and short duration agents
      1. Hydrocortisone
      2. Cortisone

III. Preparations: Opioid Analgesics

  1. See Opioid Prescribing Quantity
  2. See Opioid Prescription in Acute Pain
  3. See Opioid Adverse Effect Management
  4. See Narcotic Overdose
  5. Precautions
    1. See Emergency Department Pain Management
    2. See Acute Pain Stepped Oral Analgesics
    3. Non-Opioids are preferred for acute pain
    4. When Opioids are used for acute pain, limit to 3 days in most patients, and <7 days in almost all patients
    5. Avoid Chronic Opioids in non-Cancer Pain
  6. Opioids
    1. Weak Opioids
      1. Codeine (avoid)
      2. Hydrocodone (or in combinations, Vicodin, Lorcet, Vicoprofen)
      3. Tramadol (Ultram)
    2. Strong Opioids (WHO Step 3)
      1. Oxycodone (or in combination, Percocet)
      2. Hydromorphone (Dilaudid)
      3. Morphine Sulfate (MSIR, MS Contin)
      4. Fentanyl
      5. Methadone (Dolophine)
  7. Opioid Agonist-Antagonist
    1. Buprenorphine
    2. Butorphanol (Stadol)
    3. Nalbuphine (Nubain)
    4. Pentazocine (Talwin)
  8. Opioid Antagonist
    1. Naloxone
    2. Naltrexone
    3. Gastrointestinal Opioid Antagonist (e.g. Movantik, Methylnaltrexone, Symproic, Alvimopan)

IV. Preparations: Muscle Relaxants

  1. Skeletal Muscle Relaxant
    1. Cyclobenzaprine (Flexeril)
    2. Methocarbamol (Robaxin)
    3. Carisoprodol (Soma)
    4. Chlorzoxazone (Parafon Forte)
    5. Metaxalone (Skelaxin)
    6. Orphenadrine (Norflex)
  2. Antispastic Skeletal Muscle Relaxant
    1. Dantrolene (Dantrium)
    2. Baclofen (Lioresal)
    3. Tizanidine (Zanaflex)

V. Protocol: Approach to acute pain in adults

  1. See Acute Pain Management
  2. See Pediatric Analgesics
  3. See Acute Pain Stepped Oral Analgesics

VI. References

  1. Sachs (2005) Am Fam Physician 71(5): 913-8 [PubMed]
  2. (2000) Med Lett Drugs Ther 42:73-8 [PubMed]

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