II. 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 600-800 mg or Naproxen 500 mg dosages or
    2. Switch to another NSAID class (e.g. Sulindac) or COX2 Inhibitor (e.g. Celebrex)
  3. Step 3
    1. Consider adjunctive topical agents (e.g. Diclofenac Gel, Lidoderm patch or TENS unit) or
    2. Hydrocodone-Acetaminophen (Vicodin) 5/325 to 10/650 every 6 hours prn
  4. Step 4
    1. Oxycodone (Roxicodone) or
    2. Oxycodone with Acetaminophen (Percocet)
    3. Consider Morphine instead of Oxycodone or Hydrocodone (Morphine is less euphoric)
  5. Step 5
    1. Convert to SR when daily dose established
    2. Morphine (immediate release) 10-30 mg every 4 hours prn or
    3. Dilaudid 2-4 mg orally every 4-6 hours

III. Protocol: Adjunctive medications to consider if pain persists

IV. Protocol: Avoid Analgesics with poor efficacy and increased adverse effect risks

  1. Codeine (e.g. Tylenol #3)
  2. Propoxyphene (Darvon, Darvocet)
  3. Tramadol (Ultram)

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Ontology: Analgesics (C0002771)

Definition (MSHCZE) Sloučeniny umožňující zmírnění bolesti bez ztráty VĚDOMÍ.
Definition (MEDLINEPLUS)

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis or any number of other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.

Over-the-counter (OTC) medicines are good for many types of pain. There are two main types of OTC pain medications: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs. If OTC medicines don't relieve your pain, your doctor may prescribe something stronger. Many NSAIDs are available at prescription doses. The most powerful pain relievers are narcotics. They are very effective, but they can sometimes have serious side effects. Because of the risks, you must use them only under a doctor's supervision.

There are many things you can do to help ease pain. Pain relievers are just one part of a pain treatment plan.

Definition (NCI) Natural or synthetic compound mixtures, Analgesic Preparations relieve pain by altering the perception of nociceptive stimuli without loss of consciousness. Analgesic compounds may act at opioid receptors (morphine-like drugs) or at other central or peripheral sites (non-steroidal anti-inflammatory agents). (NCI04)
Definition (NCI_NCI-GLOSS) Drugs that reduce pain. These drugs include aspirin, acetaminophen, and ibuprofen.
Definition (NCI) Compounds that alleviate pain without loss of consciousness. Analgesics act by various mechanisms including binding with opioid receptors and decreasing inflammation. Choice of analgesic may be determined by the type of pain. These compounds include opioid, non-opioid and adjuvant analgesic agents.
Definition (CSP) compounds capable of relieving pain without the loss of consciousness or without producing anesthesia.
Definition (MSH) Compounds capable of relieving pain without the loss of CONSCIOUSNESS.
Concepts Pharmacologic Substance (T121)
MSH D000700
SnomedCT 363559009, 255630003, 373265006, 53009005
LNC LP31483-8, LP134119-9, MTHU015955
English Analgesics, Anodynes, Agents, Analgesic, Analgesic Agents, Analgesic Drugs, Drugs, Analgesic, analgesics (pain medication), analgesics (medication), pain medication, analgesics, [CN100] ANALGESICS, anodyne, pain killer drug, analgesic agents, analgesic drug, analgesic drugs, analgesics drug, analgesics drugs, anodynes, pain relieving drugs, Pain-relief Medication, Pain medicine, Pain medicines, Painkillers, Pain Relievers, ANALGESICS, Analgesic product (substance), Analgesic product, analgesic, Analgesic, Analgesic (product), Analgesic (substance), miscellaneous analgesic, Analgesic, NOS, Pain Relieving Drugs, Analgesic Preparation, Analgesic Agent
French Médicaments antidouleur, Médicaments anti-douleur, Analgésiques, Agents analgésiques, Agents antalgiques, Antalgiques, Médicaments analgésiques, Médicaments antalgiques
Swedish Smärtstillande medel
Czech analgetika, anodyna
Finnish Kipulääkkeet
Italian Agenti analgesici, Farmaci analgesici, Medicamenti anodini, Antidoloriferi, Analgesici
Russian ANALGETIKI, ANALGEZIRUIUSHCHIE SREDSTVA, BOLEUTOLIAIUSHCHIE SREDSTVA, АНАЛГЕЗИРУЮЩИЕ СРЕДСТВА, АНАЛГЕТИКИ, БОЛЕУТОЛЯЮЩИЕ СРЕДСТВА
Croatian ANALGETICI
Polish Leki przeciwbólowe, Analgetyki
Japanese 鎮痛剤, 抗痛覚物質, 鎮痛薬
Norwegian Not Translated[Analgesics]
Spanish producto analgésico (sustancia), producto analgésico, Analgésico, analgésico (producto), analgésico (sustancia), analgésico, Anodinos, Analgésicos
Portuguese Analgésico, Analgésicos, Anódinos
German Analgetika, Anodyna, Schmerzlinderungsmittel, Schmerzmittel