Overview of Pain Management

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Introduction

Revision - Essential Pain Management

Acute Pain

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Important Medication

Safe Opioid Prescribing

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Introduction
Paracetamol
NSAIDS
Opioids
Adjuvants

NSAIDS - also known as NSAIM (Non-steroidal anti-inflammatory medications)

Ibuprofen (Brufen)

Action: Mainly work by changing prostaglandin levels in peripherial tissues, thereby reducing inflammation - COX 1 and COX 2 action

Caution: Elderly/renal impairment/GI tract disease/avoid in unwell & dehydrated patients/check use peri-operatively for orthopaedics

Usual Dose

PO 400mg TDS

Consider prescribing with a PPI (e.g. omeprazole)

Advantages

Cheap, generally safe
Good for nociceptive pain
Best given regularly with paracetamol in acute pain

Disadvantages

Gastrointestinal and renal side effects
Bleeding risk

See NZ FORMULARY

Diclofenac (Voltaren)

Action: Mainly work by changing prostaglandin levels in the peripheral tissues, thereby reducing inflammation - COX 1 and COX 2 action

Caution: Elderly/renal impairment/GI tract disease/avoid in unwell & dehydrated patients/check use peri-operatively for orthopaedics

Usual Dose

PO: 25- 50mg TDS or 75mg Slow Release (SR) BD

PR: 100mg OD

IV: 75mg BD

Consider prescribing with a PPI (e.g. omeprazole)

Advantages

Cheap, generally safe
Good for nociceptive pain
Best given regularly with paracetamol

Disadvantages

Gastrointestinal and renal side effects
Bleeding risk
Some issues in patients with severe cardiovascular disease

See NZ FORMULARY

Naproxen

Often used in general practice

See NZ FORMULARY

COX 2 Inhibitors

Action: Mainly work by changing prostaglandin levels in the peripheral tissues, thereby reducing inflammation - selective COX 2 action

Caution: Elderly/renal impairment/GI tract disease/avoid in unwell & dehydrated patients/check use peri-operatively for orthopaedics

Usual Dose:

Parecoxib (intra-operative) 40mg IV OD

Celecoxib (post-operative) - used in hospital only - 100-200mg BD PO

Advantages

Cheap, generally safe
Good for nociceptive pain
Best given regularly with paracetamol in acute pain
Can be safer than other NSAIDs in patients with a history of GI disease

Disadvantages

Gastrointestinal and renal side effects
Bleeding risk
Caution in patients with cardiovascular disease and those taking aspirin

See NZ FORMULARY- Celecoxib

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