Principles Of Pain Management

In medical science every treatment goes under a proper authentic guideline verified by a trusted team or organization of health system. General principles of pain management strategy includes:


- By using appropriate interventions

• Pharmacologic
• Nonpharmacologic

- Education in the patient, family, and all caregivers around the plan
- Ongoing assessment of treatment outcomes
- Regular review of the blueprint of care
- Use of other members in the interdisciplinary team, including:

• Nurses
• Societal workers
• Pharmacists
• Chaplains
• Physiotherapists
• Work-related therapists
• Child life specialists

- Flexibility is essential - successful plans are tailored towards the individual patient and family
- Willingness to obtain help from colleagues with more expertise in the event the plan is not effective in controlling the patient’s pain


AN 8 STEP METHOD TO EXCHANGING ONE OPIOID AGENT AS WELL AS ROUTE OF ADMINISTRATION FOR A DIFFERENT

Physicians often find that the process of converting from one opioid agent a great equivalent dose of another agent, or changing the route associated with opioid administration challenging. This process is easiest to know by using morphine as the actual reference standard. By following the steps here, the physician can safely convert collected from one of opioid or route of government while maintaining adequate pain handle. It should be emphasized that patients has to be closely monitored and pain routinely assessed over the first 24 to 72 hours carrying out a change in dose or course of administration.

Step 1: Determine the overall 24-hour dose of the at the moment prescribed analgesic.

Step 2: Convert the currently prescribed opioid a great equivalent morphine dose (tables 1 along with 2).

Table 1

Approximate oral equianalgesic doses.

*Demerol (Sanofi-Synthelabo, Malvern, PA); Roxicodone and Dolophine (Roxanne Laboratories, Inc. Columbus, OH); Percocet and Percodan (Endo Pharmaceuticals Inc., Chadds Ford, PA); Tylox (Othro-McNeil Pharmaceutical, Raritan, NJ); Avinza (Ligand Pharmaceuticals, San Diego, CA); Dilaudid (Abbott Laboratories, Chicago, IL); Fentanyl Transdermal System (Jannsen Pharmaceutical, Inc., Titusville, NJ.).

Table 2

Approximate parenteral equinalgesic dose.

* Demerol (Sanofi-Synthelabo, Malvern, PA); Dolophine (Roxanne Laboratories, Inc. Columbus, OH); Dilaudid (Abbott Laboratories, Chicago, IL).

Step 3: Convert the morphine dose towards the new dose using the identical route or convert the path to the new dose using these conversion (tables 1 and 2).

• Consider reducing the dose by 50% inside elderly and patients with renal inability.
• When changing the route associated with administration, it is suggested the morphine equianalgesic dose first be determined previous to calculating the new dose (PO: IV morphine conversion is 3: 1, PO: SQ is actually 2: 1).

Step 4: Should the pain is controlled start at 50% to 75% in the equianalgesic dose. If the pain is out of control than start at 100% in the dose.

Step 5: Determine the appropriate intervals of administration (tables 1 along with 2)2) and amount per amount by dividing the dose calculated in Step by the dosing interval.

• Use the dosing schedule that is in keeping with the medication system of motion.
• OxyContin (Purdue Pharma L. V., Stamford, CT) is only approved for the q12 hour dosing schedule.
• Kadian (Faulding Laboratories Inc., Piscataway, NJ) is approved for the qd or q12 hour dosing times.
• Avinza (Ligand Pharmaceuticals, San Diego, CA) is approved limited to a qd dosing schedule.
• MS Contin (Faulding Laboratories Inc., Piscataway, NJ) is approved for the q12 hour or q8 hour dosing schedule.
• Methadone can be taken at q12, q8, or q6 depending on patient response and duration associated with action.
• Duragesic Patch (Janssen Pharmaceutica, Inc., Titusville, NJ) is approved for the q72 hour change.

Step 6: Present appropriate “rescue” dosing for development pain.

• 10% of the total opioid dose is given every 1 or 2 hours as needed.
• In the elderly, the rescue dose should be 5% in the total opioid dose administered every single 4 hours as needed.
• When using slow release preparations, intermediate release (IR) opioids are supplied for breakthrough pain with the actual dose being 1/6th to 1/3rd in the q12 hr dose (equivalent to 50% to 100% in the q4 hour dose).

Step 7: Titrate baseline in addition to being needed doses to provide effective pain alleviation.

• Add the schedule and development pain doses.
• For mild ache, increase the dose by 25% in order to 30%.
• For moderate pain boost the dose by 50%.
• For severe pain boost the dose by 50% to 100%.
• Be aware of allow for steady state to happen before additional increases. This is specially important in long-acting preparations for example methadone (5 days), OxyContin (2 in order to 3 days), Kadian (2 in order to 3 days), and Avinza (2 in order to 3 days). If the above medications are usually increased too rapidly (especially methadone) they can result in drug overdose and even passing away, most often seen with methadone.

Step 8: Cathartic and stool-softening medications ought to be started with the initiation associated with opioids.

• Docusate and senna are the ideal choice for constipation prophylaxis.
• In people that are nauseated, a bisacodyl suppository or sodium phosphate enema can be utilized.
• In cases of uncontrolled constipation, an osmotic laxative for example lactulose, magnesium citrate, or polyethylene glycol could possibly be added.