Pain Relief Flashcards
What is the care objective in pain relief?
To reduce the suffering associated with experience of pain to a degree that the patient is comfortable.
In moderate pain, consider administration of opioids and _____?
Paracetamol, where the oral route is not contraindicated.
What is procedural pain? Provide examples of moderate and severe procedural pain.
Any situation in which a patient requires supplemental analgesia for short periods of time.
Moderate - splinting fractures, reducing dislocations, transferring patients to or from the stretcher, difficult egress
Severe - extrication/manipulation of patients with severe musculoskeletal injury
What options are available if there is a delay to IV access? Which is the preferred option in moderate to severe pain?
Methoxyflurane/IN Fentanyl may be used in severe pain where there is a delay to IV access.
IN Fentanyl is the preferred option.
Opioids/ketamine should be titrated to…
Pain or side effects.
What considerations are made for small or frail patients?
Dose reductions, increased intervals.
How are emergence reactions, hallucinations managed post-ketamine administration?
Consult for 0.5 - 1mg of IV Midazolam.
What are the 6 “Assess” points in this guideline?
- Reported level of pain using scale
- Physical signs of discomfort
- Acute vs. chronic pain
- Analgesia already taken
- Opioid tolerance
- Co-morbidities
What is the analgesia option for Mild Pain?
Paracetamol, 1000mg or 500mg, oral.
What are the modifying factors for paracetamol dosages in Mild Pain?
Weight <60kg, frail, elderly, malnourished or liver disease.
What is the STOP note in the Mild Pain guideline?
Paracetamol should not be used to treat chest pain in ACS.
What are the analgesia options for Moderate Pain?
- IV Morphine up to 5mg every 5 mins, max. 20mg
- IV Fentanyl up to 50mcg every 5 mins, max. 200mcg
If IV access delayed/not required/unsuccessful:
- IN Fentanyl 200mcg, rpt. 50mcg every 5 mins
- IN Fentanyl 100mcg, rpt. 50mcg every 5 mins
If moderate procedural pain or unable to admin IN:
5. Methoxyflurane 3mL, rpt 3mL if required
- Consider paracetamol
What are the analgesia options for Severe Pain?
IV/IN options as per Moderate.
Consider Ketamine for extreme traumatic pain.
Consider IM Morphine as a last resort:
1. Morphine 0.1mg/kg once only
2. Morphine 10mg IM, rpt 5mg after 15mins, once.
What are common aetiologies of chronic pain?
Low back pain
Migraines/headache
Joint pain
Neuropathic pain (Parkinson’s, MS, post-stroke)
What are the treatment goals for breakthrough pain in the setting of chronic pain?
Ensure pt has followed their own care plan for breakthrough pain, attempt to consult with their regular health care provider, reassure and organise a medical review, if administering pain relief - partial relief is most realistic.
