Pain Management

Question 1

Principles of pain management

Answer 1

Recognise and alleviate pain from triage => beyond discharge
-within 20mins of ED arrival
Effectiveness evaluated within 30mins of 1st dose

Question 2

Why do we want to address pain

Answer 2

Slows down return of normal lung function
Adds to stress response
Haemodynamics and CV function affected
Can contribute to immobility => thromboembolic events
Slows surgical recovery => increased morbidity

Question 3

How would you assess pain

• initial assessment
• action
• reevaluation

Answer 3

Within 20mins of arrival

0 => do nothing
-reassess within 1hr of initial assessment

1-3 => PO paracetamol/NSAID
-reassess within 1hr of analgesia

4-6 => mild + PO NSAID/codeine phosphate
-reassess within 1hr of analgesia

7-10 => IV opiate/rectal NSAID
-reassess within 30mins of analgesia

Question 4

Paracetamol

• mode of admin
• dose adjustments

Answer 4

PO, PR, IV (NBM, rapid analgesia needed)

Standard dose - 1g
-adjust by weight if giving IV to patient U50kg

Question 5

NSAIDs

• mode of admin
• main 3 and their characteristics

Answer 5

PO, PR, IM, IV

Ibuprofen 400-800mg PO QDS

• fewer SE than others
• good analgesia, poor antiinflammatory

Naproxen 500mg => 250mg PO

• acute MSK pain
• fewer SE than others
• stronger antiinflammatory than ibuprofen

Diclofenac 500mg PO TDS

• renal colic pain
• AVOID IN IHD, PVD, CVD, HF

Question 6

Opiates

• key 2
• mode of admin
• when and how to use

Answer 6

Codeine phosphate

• PO, IM
• 30-60mg QDS, lower dose in elderly
• more effective when given with paracetamol

Morphine

• PO, IV, IM
• PO too slow for acute pain control in ED
• 0.1-0.2mg/kg IV but titrate up

Question 7

Entonox/penthrox

• when to use
• when to avoid

Answer 7

Entonox

• short term relief of severe pain
• peforming short uncomfortable procedures
• avoid in head/chest injuries, suspected BO, otitis media, early pregnancy, B12/folate deficiency

Penthrox