Pain Advocacy Card (Alternative Strategies for pain Control)

Around the Clock (ATC) pain?-order analgesia
ATC and reduce the 24 hour dosage by 1/2 to 1/3 of the previous day's usage when equianalgesically converting (for the initial change in medication).  (*When med. is given ATC, the overall requirement is reduced.)

Give NSAIDS (Ibuprofen 800 mgm q8h) ATC with foods unless:
    1. Renal insufficiency or failure-use Tylenol ATC (max 4000 mg/day)
    2. History of GERD or ulcers within last 5 years (use COX-2 inhibitor, Vioxx 25 mgm qd or Celebrex 200 mgm qd or bid)
    3.  Bleeding risk-use Tylenol ATC
    4.  If NPO-Toradol 10-15 mgm IV q6h (maximum of 5 days)

Switch to oral ASAP-better control and longer lasting

IV out? Don't use IM opiod.  Suggest subcutaneous-dosing is the same as IV, absorbs about 5-10 minutes slower than IV.

Demerol ordered past 3 days?  Do you want to consider switching to another opioid due to neurotoxicity and risk of seizure?

Muscle spasm?  Use Robaxin 500 mgm IV/PO q6h in addition to analgesia.

Neuropathic pain? (Described as burning, stinging, shooting, or electric-like).  Use Neurontin 100 mgm po qid to start.

Use non-pharmacologic adjuvants:
    Ice or heat/TENS unit/Splint pillow
    Relaxation/Imagery/Music-Channel 36
    PT if indicated
    Psychologic support as needed

Pain Video (Channel 4)-times-0740, 0810, 0840, 1140, 1440, 2240
Do you need a pain consult?
Days-Pager #3132 for acute pain or #4136 for chronic pain