Download PAIN MANAGEMENT in the AGED

PAIN MANAGEMENT in the AGED
PAIN MANAGEMENT
1) Ask about pain: function & level (0-10)
2) Guiding principles;
1st --Nonpharmacologic
2nd--scheduled dosing
3rd--limit side effects
3) Acute pain1st--Nonpharmacologic,
2nd--acetaminophen scheduled
3rd--narcs.--prn,1/4 usual dose (See back side)
sedation?---> ritalin 2.5 mg bid
4) Chronic pain
-evaluate cause
(inflammatory vs neuropathic)
- level (0-10), function, depression?
-therapy: (for acute pain see narcotics)
remember:- rehab.
- educate
- team concept
5) Meds.
General therapy:
-acetaminophen 1000mg qid or 650mg XL 2 tid
–Narcotics (add prn & sustained release: (reverse side)
(If needed >1 week use extended release primarily)
If inflammatory/mechanical--ADD:
--salicylates 500 mg bid->1500 mg bid (follow (asa)
levels)
other nsaid’s ½ usual dose. Avoid in renal/CHF/GI dz.
If neuropathic---ADD:
-capsaicin-0.025%-->0.075% qid "Burn is good"
-neurontin 100 mg q hs, advance q 3 d. To bid--tid
Max dose 300 mg qid
-pregabalin 50 mg p.o. tid
Max dose 100 mg tid
-duloxetine start 20 mg q d, increase to bid max
dose 60 mg q d
-nortriptyline 10 mg q hs ,max 25 mg q hs
Use levels to guide higher doses
-lamotrigine 25 mg q d, increase by 50 mg q 2 wks,
max 400 mg q d
P-A-I-N
P hysical
A nxiety
I interpersonal/social problems
N on-acceptance/spiritual distress
P hysical
(Pain) - (make sure of diagnosis (when you can)
Mech/
Inflammatory
Drug
vs.
neuropathic vs.
bone
APAP*
+
+
+
NSAIDS
+
--
+
Dexamethasone*
*
+
--
+
Opiates~
+
+/-
+
Anti-depressants
--
+
--
Anti-convulsants
--
+
--
Radiation/chemo
--
--
+
*APAP: scheduled dose and add PRN narcotics (write p.o. or p.r.)
**dexamethasone: 4-10 mg per dose
~Opiates
po/pr*
sc/iv
size
liquid
morphine
5mg q 4h*.
2mg q 2 hr
15mg
10,20,
100mg/5ml
oxycodone
2.5mg q 4h*.
---
5 mg
5 mg/5 ml.
MS Contin
15mg q 12 h*.
---
15,30,60,
100,200 mg
----
---
10, 20, 40,
80,160 mg
----
---
25,50,75,
100mcg/h
Oxycontin
10 mg q 12 h.*
Duragesic p
25 mcg/h. q 3
d*
Tramadol
50-100 mg q 46 hrs prn pain
* (these are starting doses-titrate to pain control and tolerance)
A nxiety (pain) (counsel, reassurance, family friends, pastor)
Medication
po
im/iv
size
liquid
lorazepam
0.5-2 mg t.i.d.
0.5-2 mg q 4h
0.5, 1& 2 mg
2mg/ml
0.5-2 mg q 4h
1-2 mg q 4 h.
(not IV)
haldol
I nterpersonal/spiritual-->counseling, family/friends, pastors
N on-acceptance-------------->counseling, family/friends, pastors
2mg/ml