General Therapy

                    "PAIN RELIEF PYRAMID"

Of medications the 1st choice is:
1st step: -- ACETAMINOPHEN -- (Tylenol & Tropical's)
(lowest side effect, use as scheduled does for greatest effect)

NPO ----- suggest: 650mg per rectum qid

P.O. ----- 650-1000mg qid or NEW! (XL 650mg two tid)

Compatible with NSAID's & Opiates.

(For information on NSAID's see inflammatory/mechanical later in card)

Total dose less than 4 gms/24hours

TOPICALS (see neuropathic pain for more information)

Lidocaine Patch -- apply to most painful areas; on 12 hours than leave off 12 hours

Capsaicin cream -- applied bid - tid scheduled

Next step →→→ Always add PRN narcotics
best choices: morphine sulfate or oxycodone
Why best choices ? least side effects of narcotics, most effective

PEARLS OF WISDOM
The use of scheduled dose Acetaminophen prohibits the use of narcotic/acetaminophen combinations as prn's in the therapy due to risk of acetaminophen toxicity.

If the patient is requiring ≥ three doses of PRN narcotics or the pain source will be continuing for > 3 days then begin sustained release narcotics. "For more on narcotics see later in the card"