Pain Management

• Scoring

  • Numerical rating out of 10 most common

  • FLACC validated for cognitively impaired and children

    

• Opioids

• Adjuvants
  • Neuropathic pain agents
    • First line: gabapentin, pregabalin, duloxetine, venlafaxine, TCAs
  • Muscle relaxers:
    • Cyclobenzaprine
    • Baclofen
    • Methocarbamol
    • Tizanidine
  • Topical analgesics
    • lidocaine patches/cream
    • Capsaicin
    • NSAID creams/patches
  • Non-pharmacologic
    • Physical therapy, TENS
    • Heat, ice, massage
    • Psychology: relaxation, cognitive behavioral therapies, biofeedback
    • Music therapy/aromatherapy
  • Additional Considerations:
    • Don't forget nerve blocks, injections, and epidurals if indicated!
    • Pain service consultation can help determine if patient is a candidate
• When to refer to a pain specialist?
  • You just need help
  • Potential injection:
    • Radiculopathies (sciatica, cervical)
    • Cancer-related pain
    • Post laminectomy syndrome (failed back surgery)
    • Complex regional pain syndrome
    • Joint pain
  • Counseling on opioids and adjuvant medications
  • Interdisciplinary approach
    • Physical therapy
    • Psychology

Acetaminophen:

• Usual dose: 15 mg/kg PO/IV Q 6 hours
• Max 1000 mg/dose
• Max 75 mg/kg/day (5 doses/day) or 4 grams/day

Ibuprofen:

• 10 mg/kg PO Q 6-8 hours
• </= 40 kg: max 400 mg/dose

Ketorolac: if NPO or unable to tolerate POs

• 0.5 mg/kg/dose IV Q 6-8 hours
• <50 kg: max 15 mg/dose, >/=50: max 30 mg/dose, but ideally start with 15 mg and titrate up as needed

Typical use <72 hours, NTE 5 days