Nearly every ward and nursing environment will encounter patients needing pain management. This could be as in my case, within the rehabilitation ward a few days post surgery. Or maybe acute pain the surgical ward immediatly post surgery, chronic pain in aged care facilities, during wound dressing changes with district nurses, having a port accessed during chemotherapy treatment, in the emergency department after falling.... as you can see, pain is everywhere!
Pain management can be a complex process and involve many different avenues of treatment as well as being individualised for the patient. What may work for one patient may not work for another. Therefore pain management should be multi-modal and address the individuals specific needs.
Therefore I have compiled a list of my Top 10 Analgesic medications, which may be different from yours so please let me know what you think should make the list.
10. Buprenorphine Transdermal Patch (Norspan)
This comes in at number 10 for me because its a good 'background' analgesic for patients. It does, like most opioids have multiple side effects and also the risk of dependance. Unfortunately it also takes up to 72 hours for it to fully take effect as it travels through the skin into the blood stream, therefore patient education is essential. Check out this pamphlet on Norspan Patches
9. Hydromorphone Hydrochloride (Jurnista and Dilaudid)
The two brands of Hydromorphone Hydrochloride which I tend to administer are the long acting Jurnista and short acting Dilaudid. We'll start with Jurnista, unlike other long acting opioids which tend to be b.d administration, Jurnista is taken as a daily dose which is beneficial for patients who may not be compliant with medication administration. Jurnista should be used for patients which chronic, around the clock pain that tends to range from moderate to severe. Read more about Jurnista here. Dilaudid is the short acting/quick release version of hydromorphone and you can read more about this here.
We use Ketamine as an infusion within the ward for chronic pain management. Often patients will have a 5-14 pain management impatient stay with a ketamine infusion used at low doses for neuropathic pain management in conjunction with allied health interventions such as physiotherapy, psychology input and occupational therapy. These patients may also be detoxing from other opioids as well whilst undertaking the ketamine infusion. After this infusion the results vary from patient to patient, some patients receive relief from their pain for up to 1 year, others a few months, and others no relief at all. You can read here a patients story and the effects of Ketamine.
7. Diazepam (Valium)
Or better know by its brand name, Valium. In addition to being used for treating anxiety, it can also be used to help relax muscles. Therefore, Diazepam can be beneficial in treating pain in patients which are related to spasms, such as what can occur with back pain. You can read more about Diazepam here.
6. Pregabalin (Lyrica)
Pregabalin is an anticonvulsant medication used to treat epilepsy and it can also be used to treat neuropathic pain. It can be used in conjunction with other analgesic agents to achieve effective pain relief. However, like other anticonvulsant medications, it does have the side effect of drowsiness and dizziness in some people. Some more information about Lyrica can be found here.
5. Ibuprofen (Nurofen)
Good old Nurofen, something we all have at home in the cupboard and for a good reason, it works! One thing to be mindful of with non-steroidal anti-inflammatory medications is they can negatively impact on wound healing, which is important if your patient is post op with a surgical incision. Read more here.
4. Paracetamol (Panadol)
And of course paracetamol needed to make the cut. Paracetamol is not only good for pain, but also for your patients who are spiking a temperature. Paracetamol actually works by increasing the patients pain threshold, therefore it is important to continue having regular paracetamol in conjunction with other analgesics such as Morphine as they can complement each other in their mechanisms of action. If you want to know more, click here.
Morphine tends to be used for severe pain, such as the acute pain a patient may be feeling post-operatively. As with other opioid medications, it does have significant side effects such as overdose. Therefore it is important to monitor the patient receiving morphine for any signs of overdose. Theres more on morphine here.
2. Oxycodone Hydrochloride (Endone)
Also know as Endone. This is an effective opioid medication which is used for severe pain. Working with post operative patients undertaking rehabilitation, we use this drug a lot. It generally takes about 15-30mins for this tablet to take effect, maximum effect is reached between 30-60mins and then persists for 3-6 hours. More on Endone here.
1. Oxycodone Hydrochloride and Naloxone Hydrochloride Dihydrate (Targin)
Some of you are probably wondering 'where is the Oxycontin on this list'. Targin is similar to Oxycontin but combines Naloxone with the Oxycodone. Targin is such an interesting medication, it is gradually replacing Oxycontin as it doesn't have one of the worst side effects of Oxycontin... Constipation. Because the Naloxone blocks some of the effects of the Oxycodone in the gut, it decreases the risk of the patient developing opioid induced constipation. Check it out here.
I've tried to add in different variety's of analgesic agents with different modes of delivery including transdermal, injectable and oral forms, but of course there are plenty more that didn't make it into my top 10 list.
So what makes your top 10?