Pain

Analgesic Advice

Comments

• See Pain Types and Medication Types for advice about which analgesics are best for particular types of pain.

• Be aware of the side effects and contra/indications of NSAIDs.

• If you have nerve type pain, see your doctor about medications specific for that type of pain (see Anti/depressants, Anti/convulsants, Nerve Pain).

• Calculate the 24 hour dose of morphine and convert if necessary to twice daily slow release oral morphine (MST).

• Use normal release morphine every 4 hours for breakthrough pain (single dose = 15% of total daily dose).

• If necessary the daily morphine dose can be increased by 50-100% as smaller dose increases may not produce any clinically noticeable effect).

• Alternatives to morphine include oxycodone, hydromorphone, fentanyl patches, and buprenorphine (patches and sublingually). Avoid oral demerol as it only lasts 1.5 hours.

• Remember that morphine (and any other morphine-like drug) causes constipation. The best cure for this is lactulose (for lubrication) plus senna (for movement).

• Nausea and vomiting can be troublesome initially but usually passes with acclimatisation. If you are actively vomiting then anti-emetics by mouth will be ineffective. Some anti-emetics are available sublingually or by suppository and can therefore bypass this problem.

• Consider Pain Clinic referral for specific non-drug interventions e.g. nerve blocks, epidural injections, joint injections etc.