Medication Management Pain

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Medication Management Pain

• Successful pain management can improve quality of
  life and behaviour

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Treatment of pain

• Massage
• Applications of heat / cold
• Relaxation techniques,
• Distraction, repositioning
• TENS
• Exercise
• Physiotherapy
• Medications

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Other conditions that can impact on pain

• Depression
• Insomnia
• Anxiety, anger or fear
• Constipation
• Cold

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Medications for pain

• Paracetamol
• NSAIDs
• Opioids

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Paracetamol

• Up to 4G per day (2 QID)
• More effective if a regular dose
• Caution in residents with
• reduced hepatic function

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NSAIDS, Cox 2

• Avoid if possible
• Use small doses for short
• periods of time
• Caution in residents with
• Reduced renal function
• Gastrointestinal irritation

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Adverse effects of NSAIDS

• Gastrointestinal bleeding
• Renal Failure
• Heart Failure
• Bronchospasm
• Elevated BP
• Dyspepsia, Nausea, Headache, Fluid Retention
• Blood Dyscrasias

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Opiates

• Long acting morphine
• M S Contin
• Kapanol
• Morphine liquid
• Endone
• Proladone Suppos
• Fentanyl patches

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Adverse effects of Opiates

• Constipation
• Ensure bowel management added
• Sedation
• There may be other sedative medication
• Respiratory depression
• There may be medications to help breathing
• Tolerance
• Possibility if dose has increased
• Nausea

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Add Paracetamol

• Paracetamol can increase the effect of opiates so
  can lengthen time that medications effective

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Other Options

• Opiates and Non Opiates
• Can use Panadeine Forte and Paracetamol
• eg 1 Panadeine Forte QID and
• 1 Paracetamol QID

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Tramadol (Tramal)

• Dose 50-100mg every 4 to 6 hours
• Not as sedating

• Can cause adverse effects
• Confusion
• Orthostatic Hypotension
• Hallucinations
• Seizures
• Serotonin Sydrome

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Other treatments

• Corticosteroids for inflammatory pain
• Antidepressents for neuropathic pain

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If pain is not controlled

• The resident can be
• Depressed
• Unwilling to participate in activities
• Have sleep disturbances
• Reduced mobility
• React aggressively to movement

Psychotropic use
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Good news

• Once pain control has been achieved, a trial dose
  reduction is good practice

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Role of Pain Assessments

• Duty of Care
• Care Plan
• ACFI
• Changes in resident needs
• If pain relief required for acute problem, need
  to reassess
• Worsening of condition, need to reassess