Pain management

Pain: (in general: i.e. headache)

  • Mild-Moderate pain:
    1. Tylenol 325-650mg PO q4-6hrs PRN mild pain or fever > +101 F.
    2. Ibuprofen (Motrin: NSAID: GI BLEED!) 600mg PO q6hrs PRN for mild pain
      1. Meloxicam – less risk of bleeding with GERD!!!
        1. Stop Ibuprofen and change to Meloxicam (less acid reflux).
  • Moderate pain:
    1. Lidocaine (Lidoderm) 5% patch 1 patch transdermal qd
    2. Fentanyl patch – 1 patch transdermal qd
    3. Toradol (Ketorolac – NSAID: GI BLEED!): 15-30mg PO/IM/IV q6hrs (no more than 5 days)
    4. Darvocet N100 1 tab PO q4hrs
    5. Tramadol (Ultram) 50-100mg PO q4-8hrs (Opioid)
    6. Oxycodone 10mg PO q4hrs
    7. Percocet 5/325 (oxycodone/acetaminophen) 1-2 tabs PO q4hrs
    8. Lortab 5/325 1-2 tabs PO q4hrs
  • Moderate-Severe pain:
    1. Morphine 1-2mg IM/IV X 1 dose for severe pain (use sparingly) or q3-4hrs PRN
    2. Dilaudid (1mg Dilaudid = 7mg Morphine) 0.5-2mg IM/IV – use sparingly.

Morphine Equivalents:

morphine equivalents




Use the above conversion table when calculating Morphine equivalents.

Look patient up on CSMD to assess for outpatient controlled substance prescriptions.

Pain (arthritic):

  • Voltaren Gel (NSAID) used for the relief of joint pain of osteoarthritis in the knees, ankles, feet, elbows, wrists, etc.
    1. Voltaren 1% transdermal gel: apply sparingly to affected areas bid.

Pain post-op (patient started on PCA pump by surgery):

  • Surgery will start these orders and may want to maintain their own PCA pump orders. If you are paged by a nurse about PCA pump questions/issues/pain control or lack thereof/wild vitals secondary to lack of pain control, consider asking the nurse to:
    1. Recheck vitals (if they were abnormal).
    2. Contact surgery so that they may manage the PCA pump orders that the initiated or manage the pumped yourself:
      1. Ex: Dilaudid PCA. Basal rate: 0.3mg/hr (7.5mg/day) Bolus rate: 0.1mg q20min (7.5mg/day). Lockout at 2mg/hr.
      2. Make sure that you also have: Naloxone (opioid antagonist): Give if signs of resp. failure.
      3. Cocaine is NOT an opioid. Cocaine is derived from the coca plant whereas opiates (and thus opioids) are derived from the opium poppy.
    3. Contact that nurse 30min-1hr later for an update on the patient and/or go by the patient’s room.

Pain/stiffness secondary to muscle spasms/cramps:

  • Cyclobenzaprine (Flexeril) 10mg 1 tab PO q8hr PRN (muscle relaxer)
  • Methocarbamol (Robaxin)
  • Metaxalone (Skelaxin)
  • Tizanidine (Zanaflex)

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