Analgesic

Analgesic

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Analgesic, Oral Analgesic

  1. See Emergency Department Pain Management
  2. Non-Opioids are preferred for acute pain
  3. When Opioids are used, limit to 3 days in most patients, and <7 days in almost all patients
  4. Avoid Chronic Opioids in non-Cancer Pain
  • Protocol
  • Approach to acute pain in adults
  1. Step 1: Acetaminophen with or without Ibuprofen
    1. Acetaminophen 1000 mg orally every 6 hours
      1. Considered best first-line Oral Analgesic
      2. Safe and effective for most mild to moderate pain
      3. Does not have antiinflammatory activity
    2. Ibuprofen 400 mg orally every 6 hours
      1. GI safety similar to Placebo up to 1200 mg/day
      2. More effective in Dental Pain and Dysmenorrhea
      3. Antiinflammatory activity starts at 600 mg doses
  2. Step 2
    1. Advance to higher Ibuprofen 600-800 mg or Naproxen 500 mg dosages or
    2. Switch to another NSAID class (e.g. Sulindac) or COX2 Inhibitor (e.g. Celebrex)
  3. Step 3
    1. Consider adjunctive topical agents (e.g. Diclofenac Gel, Lidoderm patch or TENS unit) or
    2. Hydrocodone-Acetaminophen (Vicodin) 5/325 to 10/650 every 6 hours prn
  4. Step 4
    1. Oxycodone (Roxicodone) or
    2. Oxycodone with Acetaminophen (Percocet)
    3. Consider Morphine instead of Oxycodone or Hydrocodone (Morphine is less euphoric)
  5. Step 5
    1. Convert to SR when daily dose established
    2. Morphine (immediate release) 10-30 mg every 4 hours prn or
    3. Dilaudid 2-4 mg orally every 4-6 hours
  • Protocol
  • Adjunctive medications to consider if pain persists
  • Protocol
  • Avoid Analgesics with poor efficacy and increased adverse effect risks
  1. Codeine (e.g. Tylenol #3)
  2. Propoxyphene (Darvon, Darvocet)
  3. Tramadol (Ultram)