Types of analgesia
- Good for mild to moderate pain. Use iv route in severe acute pain.
- Contraindicated in severe hepatic impairment, dose reduce in mild impairment (e.g. 500mg QDS).
- Generally safe (except in overdose) and can be used in pregnancy
- Prescribe: Paracetamol 1g four times a day orally
- Regular is better than PRN as paracetamol acts in conjunction with other analgesia (e.g. opiates) to increase efficacy
- Very good in inflammatory or musculoskeletal pain. Consider alternative routes e.g. topical/PR.
- Contraindicated in peptic ulcer disease, previous hypersensitivity to NSAIDs or aspirin, severe heart failure and pregnancy. If using long term monitor renal and liver function regularly.
- Prescribe: Ibuprofen 200-400mg orally up to four times a day PRN
- If using regularly cover with a proton pump inhibitor (PPI) such as omeprazole (20mg orally once a day).
- Weak Opioids (click here for opioid section)
- Strong Opioids (click here for opioid section)
- e.g. Morphine, oxycodone, fentanyl
- Remember tramadol now classed as strong opioid
- Neuropathic Agents
- Usually antidepressant or antiepileptic drugs and often work well as an adjunct to the analgesia above.
- Click here for NICE guidance on neuropathic pain
- First line: amitriptyline (e.g. 10mg ON), duloxetine, gabapentin or pregabalin (see national/local prescribing guidelines).
- Tramadol has some neuropathic properties and can be used for acute rescue therapy
- Benzodiazepines, steroids, lidocaine, bisphosphonate, baclofen, hyoscine butylbromide, ketamine
- Advice from local pain or specialist palliative care services should be sought when considering these options
NB Please always read local and national prescribing guidelines (e.g. BNF) if unfamiliar with drugs, paying particular attention to contraindications, interactions and side effects.
Perfect revision for medical students, finals, OSCEs and MRCP PACES