Pain control
| Agent | Oral | Parenteral |
|---|---|---|
| Step1. Mild Pain, Nonopiod, +/- Adjuvant | ||
| Acetaminophen | 650mg q4-q6h prn or 1000mg q6h prn | - |
| Aspirin | 650mg q4-6h prn or 1000mg q6h prn | - |
| Ibuprofen | 400-800mg q6-8h prn | - |
| Gabapentin (neuropathic Pain) | Start 300mg qhs | - |
| Step2. Mod Pain, Opiod for mild/mod pain, +/-nonopiod, +/-Adjuvant | ||
| Hydrocodone (5mg/Acetaminophen 325mg) | 1-2 tabs PO q4-6h prn | - |
| Oxycodone (5mg/Acetaminophen 325mg) | 1-2 tabs PO q4h prn | - |
| Oxycodone (Oxycontin) | 5mg q4-6h | - |
| Tramadol | 50-100mg q4-6h (max 400mg/day) | - |
| Step3. Severe Pain, Opiod for mod/sev pain, +/- nonopiod, +/-Adjuvant | ||
| Morphine | 10-30mg q3-4h | 0.1-0.2 mg/kg(up to 15mg q4h) |
| Morphine (controlled release) | Start 30mg q8-12h , increase prn to 90-120mg q12h | - |
| Fentanyl | - | 1 mcg/kg q1-3h |
| Hydromorphone (Dilaudid) | 2-4mg q4-6h | 1-4mg q4-6h |
| Levorphanol | 2mg q6-8h |
2mg q6-8h |
^In elders, use a bulk laxative and give instructions regarding activity, hydration and close follow-up
See Also
References
- World Health Organization 3-Step Analgesia Ladder for Cancer & Washington Manual Intership Survival Guide, 2008