Professional Documents
Culture Documents
Red Flags Unrelieved pain should raise a red flag that attracts the attention of the interdisciplinary team.
Severe Pain 7 - 10 / 10 Step3: Startstrongoralopioidaroundtheclockii Morphine510mgq4htitratetopain Dilaudid14mgq4htitratetopain MSContinorotherlongacting3060mgq812h Fentanyl25g/hourplusMorphineSulphate5mg.q2 hoursforbreakthrough*nevertobeadministeredto opioidnaiveclients +Adjuvants* Notes:Useshortactingpreparationofsamemedication forbreakthroughpain.Considerlowerdoseinopioidnave andelderlypatients
Painpersistingor increasing
Moderate Pain 4 6 / 10
Painpersistingor Mild Pain increasing 1 3 / 10 Step1: Nonnarcoticaroundtheclock2 Acetaminophen650mgq4hor ASA650mgq4hor Ibuprofen400mgq4hor otherNSAIDs +Adjuvants* *Adjuvanttherapymedicationsthatcanhelptoenhancetheeffectsofnonopioidandopioidanalgesics 1)NSAIDs(nonsteroidalantiinflammatories)canbeusedascoanalgesicsandareusefulinreducinginflammation 2)TricyclicantidepressantsNortriptyline,Desipramine,andAmitriptylineareoptions,althoughAmitriptylinecancauseconfusion intheelderly.Studieshaveconfirmedtheireffectivenessintreatingdiabeticneuropathyandneuropathicpainfromothersources 3)AnticonvulsantmedicationsGabapentin,Pregabalin,andCarbamazepinecanrelievetheshooting,electricalpainsofperipheral nervedysfunction.iii
i
SWRWCToolkit_B.5.3WHOPainLadderwithPainManagementGuidelines_Jan7_2011AdaptedfromaCarePartners/ETNOWformwith permission2010.Appropriatecreditorcitationmustappearonallcopiedmaterials.