Adult Pain Relief CPG

Question 1

What must you asses for a pt’s complaint of pain?

Answer 1

• Reported level of pain (using pain scale)
• Physical signs of discomfort (and document)
• Acute vs chronic
• Analgesia already taken
• Opioid tolerance
• Co-morbidities

Question 2

What are the three categories of pain?

Answer 2

Mild, Moderate & Severe

Question 3

Describe your actions for someone suffering from Mild pain

Answer 3

• Paracetamol 1000 mg oral if not already taken in the past 4 hours
• If elderly or frail, weight ≤ 60 kg, malnourished or liver disease - Paracetamol 500 mg oral
  If pain not controlled or rapid pain relief required, consider treating as per Moderate pain

Question 4

Describe your actions for someone suffering from Moderate pain

Answer 4

IV access available:
- Morphine IV OR Fentanyl IV as per Severe pain
- If IV access not required, delayed or unsuccessful: Fentanyl IN
- If elderly or frail or weight ≤ 60 kg:
- Fentanyl 100 mcg IN repeat up to Fentanyl 50 mcg IN at 5/60 with max dose of 200 mcg. Titrating to pain or side effects.
- All other adults:
- Fentanyl 200 mcg IN repeat up to Fentanyl 50 mcg IN at 5/60 with max dose of 400 mcg. Titrating to pain or side effects
If unable to administer Fentanyl IN:
- Methoxyflurane 3 mL inhaled, repeat 3 mL if required, max dose of 6 mL

Question 5

Describe your actions for someone suffering from Severe pain

Answer 5

IV access available:
- Morphine up to 5 mg IV repeat up to 5 mg at 5/60 to a max dose of 20 mg. Titrating to pain or side effects
- If C/I to Morphine or if specifically indicated in Special Notes: Fentanyl up to 50 mcg IV repeat up to 50 mcg at 5/60 to a max dose of 200 mcg. Titrating to pain or side effects
If IV access delayed or unsuccessful:
- Fentanyl IN or Methoxyflurane as per Mod pain
- Consider Morphine IM as last resort
- If elderly or frail or weight ≤ 60 kg: Morphine 0.1 mg/kg IM (single dose)
- All other adults: Morphine 10 mg IM repeat Morphine 5 mg IM after 15/60 if required (once only)