pain management Flashcards
pain ladder management
mild pain:
- non opiates - paracetamol, aspirin, NSAIDs
mild-moderate pain:
- weak opioids -codeine, dihydrocodeine OTC - no longer than 3 days
- moderate - tramadol (lowers seizure threshold, serotonin syndrome, increases risk of bleed, pyschiatric disorders)
severe pain:
- strong opioids - morphine, oxycodone, methadone, buprenorphine, fentanyl
- no max dose for morphine - depends on weight & tolerance
codeine imp points
use in patients > 12
codeine linctus > 18
do not use in children < 18 who had tonsils removed due to sleep apnoea
do not use in ultra-rapid metabolisers (afro carribean) due to toxicity
do not use in breastfeeding pts
opiate side effects?
act on mu pathway causing:
- dry mouth
- constipation
- CNS depression
- nausea and vomiting
- hypotension
- miosis (pupil constriction)
strong opiates imp points
prolonged use - hypogonadism, adrenal insufficiency, hyperalgesia
overdose - use naloxone
avoid in paralytic ileus, respiratory disease (reduces resp rate) and head injury
breakthrough pain - 1/6th to 1/10th of total daily dose - every 2-4 hours
- max use 6 times a day
increase dose 1/2 to 1/3rd each day
reduce dose by 1/2 to 1/3rd when switching opiates - to reduce overdose
oxycodone - more potent than morphine - preferred in pts who can’t consume large quantities due to nausea
patches - avoid heat exposure, apply to dry hairless area, rotate site
fentanyl - remove patch immediately - if any signs of toxicity
whats used in neuropathic pain
TCAs - amitriptyline, nortriptyline
anti-epileptics - gabapentin, pregablin
- gabapentin - reduce dose gradually over 1 week if stopping
opiates - tramadol, oxycodone, morphine
topical localised - lidocaine, capsaicin
pregablin and pregnancy
pregablin may increase risk of major congenital malformations if used in pregnancy
Pt should continue to use effective contraception during treatment and avoid use unless necessary
