We’ve covered pain physiology. Now it’s time to get into the good stuff – what we can do to actually treat pain. In this episode, we talk about some of the common prehospital pain options as well as one that may be less common. Have you considered what medications you can use to improve your care alongside your standard pain management regimen? We also mention some cautions and pitfalls associated with the different medications as well.
Acute pain protocol for moderate/severe pain
by Ed Gentile, MD (Sourced from EMCrit, see link in Show Notes)
- Administer morphine 0.1 mg/kg IVP (If pt is > 55 y/o, substitute morphine 0.05 mg/kg IVP for this 1st dose)
+ diphenhydramine 0.5 mg/kg IVP
- 7 minutes later the patient is asked, “Would you like more pain medicine?”
- If the answer is yes, give a 2nd dose of morphine 0.05 mg/kg IVP
- 7 minutes later, the patient is asked again, “Would you like more pain medicine?”
- If the answer is yes, give a 3rd dose of morphine 0.05 mg/kg IVP
- This continues every 7 minutes until the patient answers “no” to the question or the patient is asleep.
- EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile *** RECOMMENDED ***
- International Narcotics Control Board – 2011 Report
- Blogspot – Opiophilia: How Heroin is Made
- O’Connor, A. B., Lang, V. J., & Quill, T. E. (2006). Underdosing of morphine in comparison with other parenteral opioids in an acute hospital: a quality of care challenge. Pain medicine (Malden, Mass.), 4, 299–307.
- Larijani, G. E., Goldberg, M. E., Gratz, I., & Warshal, D. P. (2004). Analgesic and hemodynamic effects of a single 7.5-mg intravenous dose of morphine in patients with moderate-to-severe postoperative pain. Pharmacotherapy, 12, 1675–1680.
- Aubrun, F., Mazoit, J. X., & Riou, B. (2012). Postoperative intravenous morphine titration. British Journal of Anaesthesia, 2, 193–201.
- Carr, K. D., Hiller, J. M., & Simon, E. J. (1985). Diphenhydramine potentiates narcotic but not endogenous opioid analgesia. Neuropeptides, 4-6, 411–414.
- Chang, A. K., Bijur, P. E., Holden, L., & Gallagher, E. J. (2015). Efficacy of an Acute Pain Titration Protocol Driven by Patient Response to a Simple Query: Do You Want More Pain Medication? Annals of emergency medicine, doi: 10.1016/j.annemergmed.2015.04.035
- Strayer, R. (2015, December). Ketamine: How to use it fearlessly for all its indications. Retrieved from http://www.smacc.net.au/2015/12/ketamine-how-to-use-it-fearlessly-for-all-its-indications-by-reuben-strayer/