Acute and chronic pain management.
Regimens
Step 1
Paracetamol 1 g PO/IV QDS ± NSAID (ibuprofen 400 mg TDS)
Step 2
Add weak opioid: codeine 30–60 mg QDS or tramadol 50–100 mg QDS
Step 3
Strong opioid: morphine IR 5–10 mg PO/SC 4-hourly, titrate; convert to MR
Neuropathic
Amitriptyline 10 mg nocte or gabapentin 100–300 mg TDS or pregabalin 75 mg BD
Monitoring
- • Pain score, sedation, RR, bowels
- • Renal function for NSAIDs/opioids
Common prescribing errors
- ⚠ NSAID in CKD, HF, GI bleed risk
- ⚠ Codeine in <12 y / breast-feeding
- ⚠ Failure to prescribe laxative with opioid
