"PAIN RELIEF PYRAMID"
Of medications the 1st
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
→→→ 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"