Analgesics

Abstract

It is the responsibility of the professional care team to develop an effective person-centred Pain Management strategy which appropriately assesses patients, analyses the results of the assessment and devises a person centred plan to manage pain while allowing the person to remain as independent and functional as possible. The medications useful in treating acute pain are similar to those used in treating other types of pain. The World Health Organization (WHO) analgesic ladder developed for treating patients with cancer pain also provides a useful approach to treat acute pain. At the lowest level (mild pain) are recommended nonopioid analgesics such as paracetamol or/plus nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprophen). Such drugs have an analgesic ceiling; above a certain dose, no further analgesia is expected. For moderate pain, are recommended combining paracetamol and/or a NSAID with an opioid (a weak opoid). The inclusion of paracetamol limits the amount of opoids that should be used within 24 hour period, with many benefits which will be discussed later in the chapter. For severe level of pain, a strong opoid such as morphine is a better choice; such opoids have no analgesic ceiling. Most postoperative or trauma patients initially respond better to a morphine-equivalent opoid. At the moment when the patient is eating and drinking, a combination of oral analgesics including opoids and paracetamol plus/minus NSAID are most of the time an adequate choice.