Analgesic

1. See Also
   1. Chronic Pain Management
   2. Pediatric Analgesics
   3. Chronic Narcotic Guideline
2. Protocol: Approach to acute pain in adults
   1. Step 1: Acetaminophen with or without Ibuprofen
      1. Acetaminophen 1000 mg orally every 6 hours
         1. Considered best first-line Oral Analgesic
         2. Safe and effective for most mild to moderate pain
         3. Does not have antiinflammatory activity
      2. Ibuprofen 400 mg orally every 6 hours
         1. GI safety similar to Placebo up to 1200 mg/day
         2. More effective in dental pain and Dysmenorrhea
         3. Antiinflammatory activity starts at 600 mg doses
   2. Step 2
      1. Advance to higher Ibuprofen or Naproxen dosages or
      2. Hydrocodone-Acetaminophen (Vicodin)
         1. Dose 7.5/750 to 10/1000 every 6 hours prn
   3. Step 3
      1. Switch to another NSAID class or COX2-Inhibitor or
      2. Oxycodone (Roxicodone) or
      3. Oxycodone with Acetaminophen (Percocet)
   4. Step 4
      1. Morphine (immediate release) 10 mg q4 hours prn
      2. Convert to SR when daily dose established
3. Protocol: Adjunctive medications to consider if pain persists
   1. See Chronic Pain Management
   2. Tricyclic Antidepressants (e.g. Amitriptyline)
   3. Anticonvulsants (e.g. Gabapentin)
4. Protocol: Avoid Analgesics with poor efficacy
   1. Codeine (e.g. Tylenol #3)
   2. Propoxyphene (Darvon, Darvocet)
   3. Tramadol (Ultram)
5. References
   1. Sachs (2005) Am Fam Physician 71(5): 913-8
   2. (2000) Med Lett Drugs Ther 42:73-8