Pharm Analgesia Ladder + Key Aspects

Question 1

What is Step 1 of the pain ladder?

Answer 1

Non-opioid medications such as IV paracetamol (1g). If the patient weighs less than 50kg, give a child dose of 500mg. NSAIDs are also included in Step 1: naproxen, diclofenac (pr), ibuprofen.

Question 2

What is Step 2 of the pain ladder?

Answer 2

Weak opioids such as codeine/cocodamol. Tramadol can be used in both nociceptive and neuropathic pain. Dihydrocodeine is used in 10 percent of patients not responding to codeine.

Question 3

What is Step 3 of the pain ladder?

Answer 3

Opioids such as morphine (oramorph conc 10mg per 5ml), oxycodone (used in mild to moderate renal impairment), fentanyl (50-100 times more potent than morphine), methadone, and buprenorphine. Be aware of addiction, dependence, hallucinations, headaches, and respiratory depression.

Question 4

Is fentanyl or morphine more potent?

Answer 4

Fentanyl is more potent than morphine.

Question 5

What is given for neuropathic pain?

Answer 5

Amitriptyline (higher doses may affect mental health, lower doses for pain), duloxetine (SNRI), gabapentin (titrating dose), and pregabalin.