Nursing Interventions for Acute Pain Aspirin irreversibly inhibits COX-1 and COX-2 enzymes in a dose-dependent manner. ), Intermediate outcomes (e.g., range of motion, physical strength, etc. Technical Experts do not do analysis of any kind nor do they contribute to the writing of the report. Sphenopalatine block. Rated as the degree to which studies for a given outcome are likely to reduce bias based on study design and conduct. Assessing Applicability: Applicability to U.S. practice settings and the Medicare population (i.e., persons eligible for Medicare due to age 65 or disability [including ESRD]) will be assessed based on the EPC Methods Guide, using the PICOTS framework.40 Applicability refers to the degree to which outcomes associated with the intervention are likely to be similar across patients and settings relevant to the care of the Medicare population based on the populations, interventions, comparisons, and outcomes synthesized across included studies. Determine if there are other symptoms, ask about the characteristics of their pain (PQRSTU questions), and perform a physical examination as needed. We will not exclude studies rated poor quality a priori, but poor-quality studies will be considered less reliable than higher-quality studies when synthesizing the evidence, particularly if discrepancies between studies are present. If sufficient numbers of RCTs (>10) are available, quantitative funnel plot analysis may be done. Hand Searching: Reference lists of included articles will also be reviewed for includable literature. age, gender); (2) patient medical and psychiatric comorbidities; (3) the type of treatment used; (4) the frequency of therapy; (5) the duration of therapy? Management should include a review of treatment expectations and a plan for the time course of prescriptions. (medline or medlars or embase or pubmed or cochrane).tw,sh. The use of gabapentinoids has been studied as a strategy to decrease the use of opioids in the perioperative period with mixed results. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Moderate:We are moderately confident that the estimate of effect lies close to the true effect for this outcome. (risk and (predict$ or assess$)).ti,ab,kf. Nonselective NSAIDs are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease. InsufficientWe have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome. The EPC will complete a disposition of all peer review comments. Also searched were the Agency for Healthcare Research and Quality, Clinical Evidence, the Cochrane database, Essential Evidence Plus, and the National Guideline Clearing-house database. Because of COX-1 inhibition, nonselective NSAIDs may cause GI adverse effects, such as dyspepsia, ulcerative disease, and bleeding, especially in older patients and with larger doses or prolonged use.27 Among commonly used NSAIDs, ibuprofen has a lower risk of upper GI complications.27 The GI risk of nonselective NSAIDs can be mitigated by coprescribing a proton pump inhibitor; however, this adds cost and contributes to polypharmacy.28 Nonselective NSAIDs are less expensive and are typically available without a prescription. Unintentional acetaminophen overdose is the leading cause of acute liver failure in the United States, often attributed to accidental supratherapeutic use.37 In one study, 38% of patients admitted to tertiary care centers with unintentional overdoses took two or more acetaminophen preparations simultaneously, and 63% used compounds that also contained opioids.37 In many patients, using more than the maximum daily dosage of acetaminophen (3,000 mg) may cause significant elevations in alanine transaminase levels (i.e., greater than three times the upper limit of normal).38, Patients with severe alcohol use disorder, malnutrition, or advanced hepatic disease may use acetaminophen but at daily dosages of 2,000 mg or lower. Rockville, MD 20857 This protocol will be registered in the international prospective register of systematic reviews (PROSPERO). For subquestion F, we will include studies that evaluate the performance of a risk prediction instrument against a reference standard for opioid misuse, opioid use disorder, or overdose. NSAIDs increase the risk of cardiovascular events, including myocardial infarction, stroke, and death, by about 30%.29,30 Even short-term NSAID use is cautioned in patients with a high baseline risk of cardiovascular disease; however, selecting an NSAID associated with a lower cardiovascular risk (e.g., naproxen) may be considered.30 Selective COX-2 inhibitors carry a U.S. Food and Drug Administration boxed warning because of a higher incidence of thrombotic cardiovascular events; the risk is dose-dependent.31 NSAIDs may also cause acute kidney injury as a result of reduced renal blood flow.29,32,33 The use of NSAIDs is cautioned in patients with chronic renal disease, older age, or volume-depleted states. Pain control regimens must take into account medical, psychological, and physical condition . Due to nausea and vomiting, she is given acetaminophen via suppository. ((hand adj2 search$) or (manual$ adj2 search$)).tw,sh. This project was funded under Contract No. Supplemental Evidence and Data for Systematic review (SEADS): Manufacturers and other stakeholders of included drugs and devices will be informed about submitting information relevant to this review using a Federal Register notification. A record of studies excluded at the full-text level with reasons for exclusion will be maintained. Predefined criteria will be used to assess the quality of individual controlled trials, systematic reviews, and observational studies. Patients HCP suspected diverticulitis, but did not want to undergo an endoscopy. Distinguish between chronic and acute pain using a numeric pain scale. . Patient pain levels every two hours until it falls below 3. Searches will be updated while the draft report is open to public comment, to capture any new publications. Evaluate the patients pain-related contributing variables, the suitability of the planned interventions, and efficient ways to gauge the patients reaction. Persons eligible for Medicare due to age or disability are highly impacted by pain. It serves as a warning of a disease or threat to the body. The interventional procedures for this review are: This review does not address minimally invasive surgical procedures. Copyright 2023 American Academy of Family Physicians. Chronic pain, often conceptualized as pain that persists past normal healing time (e.g., >3 months),1 is a serious public health issue in the United States, affecting approximately 50 million people and resulting in $635 billion in costs.2,3 Chronic pain substantially impacts physical and mental functioning, reducing productivity and quality of life. The magnitude of effects for pain and function will be classified using the same system used in other recent AHRQ reviews conducted on pain.47-51 Using the same classifications provides a consistent benchmark for comparing results of pain interventions across reviews. Medication choice depends on cost, availability, dosing schedule, and adverse effect profile. Internet Citation: Topical NSAIDs have a low risk of gastrointestinal (GI) bleeding, even with long-term use; however, patients at high risk should be cautious. Topical NSAIDs can be rubbed directly on unbroken skin or applied via a transdermal patch and are effective for acute musculoskeletal strains and sprains. This systematic review will evaluate the effectiveness and harms of selected interventional procedures in the Medicare population. For example, exclusion of acute pain patients with psychiatric comorbidities reduces applicability to clinical practice since many patients with chronic pain have such comorbidities, and may respond more poorly to treatment. Intravenous ketamine (Ketalar), a phencyclidine analogue and dissociative anesthetic agent that is used in subanesthetic doses for acute pain, has some evidence of benefit when used with opioids.47 Intravenous ketamine has been used as an adjunctive and stand-alone agent for perioperative pain in patients who are opioid tolerant or at high risk of respiratory depression.48,49 Intranasal ketamine has been used to treat acute pain in the emergency department,50,51 but larger studies are needed before routine use can be recommended. (vertebroplasty or kyphoplasty).ti,ab,kf. For patients with acute pain being considered for opioid therapy, what is the accuracy of instruments for predicting risk of opioid misuse, opioid use disorder, or overdose? (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$).tw,sh. Consistency (consistent, inconsistent, or unknown/not applicable), Rated by degree to which studies find similar magnitude of effect (i.e., range sizes are similar) or same direction of effect (i.e., effect sizes have the same sign), Rated by degree to which the outcome is directly or indirectly related to health outcomes of interest. Acetaminophen is well tolerated; however, lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder. Applicability addresses the extent to which outcomes associated with an intervention are likely to be similar across different patients and settings in clinical practice based on the populations, interventions, comparisons, and outcomes evaluated in the studies. It differs from standard radiofrequency ablation by using a larger, "cooled" radiofrequency probe that keeps the tip cool, potentially resulting in a larger and more effective lesion. Intradiscal stem cells. Intradiscal and facet joint platelet rich plasma. A myriad of interventional procedures and techniques are available for pain. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Interventional Treatments for Acute and Chronic Pain: Systematic Review, https://effectivehealthcare.ahrq.gov/products/interventional-treatments-pain/protocol, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, 2018 Annual Surveillance Report of Drug-Related Risks and OutcomesUnited States, Pain Management Best Practices Inter-Agency Task Force Report: Updates, Apps, Inconsistencies, and Recommendations, Methods Guide for Effectiveness and Comparative Effectiveness Reviews, Cochrane Handbook for Systematic Reviews of Interventions. Observe the oxygen saturation levels. chronic pain/ or acute pain/ or exp arthralgia/ or exp back pain/ or exp headache/ or exp musculoskeletal pain/ or neck pain/ or exp neuralgia/ or exp nociceptive pain/ or pain, intractable/ or fibromyalgia/ or myalgia/ or exp peripheral nervous system diseases/. A literature search was conducted in 4 databases. Literature identified during the updated search will be assessed by following the same process of dual review as all other studies considered for inclusion in the report. Nonopioid therapy: pain, function, pain relief satisfaction, quality of life and quality of life, harms, adverse events, opioid use, Noninvasive nonpharmacological therapy: pain, function, pain relief satisfaction, quality of life and quality of life, harms, adverse events, opioid use, e. cohort studies (for long-term opioid use), h. cohort studies and before-after studies assessing effects on prescribing rates, Abbreviations: RCT = randomized controlled trial. Key Question 1: What are the effectiveness and harms of selected interventional procedures (vertebral augmentation procedures, piriformis injection, sphenopalatine block, occipital nerve stimulation, cooled or pulsed radiofrequency ablation, intradiscal and facet joint platelet rich plasma, intradiscal methylene blue, intradiscal ozone, and peripheral nerve stimulation) versus placebo, a sham procedure, or no interventional procedure for Medicare beneficiaries with pain? Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain. The treatment of acute pain is a topic in need of an up-to-date overview of available evidence. Pain is nearly universal, contributing substantially to morbidity, mortality, disability, and healthcare system burdens.1 Acute pain usually lasts for less than 7 days but often extends up to 30 days, and may recur periodically. After surgery, additional goals are to achieve early postoperative mobilization and reduce length of hospital stay. In an example client case, the client is a 92-year old woman who was admitted to the hospital with acute pain. An overview of Cochrane reviews showed that ibuprofen, 200 mg, alone has a number needed to treat (NNT) of 3 to achieve a 50% reduction in pain, whereas the same dose of ibuprofen combined with acetaminophen, 500 mg, has an NNT of 1.6. For subquestion G, we will include RCTs, cohort studies, or before-after studies that evaluate effects on prescribing rates. We believe that the findings are likely to be stable, but some doubt remains. When quantitative synthesis is not possible, sample size and assessment of variance within individual studies will be considered. The Technical Expert Panel is selected to provide broad expertise and perspectives specific to the topic under development. These non-pharmacological interventions may include, but are not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, laser therapy, low-level light therapy, meditation, biofeedback, hypnosis and relaxation techniques. The disposition of comments for systematic reviews and technical briefs will be published 3 months after publication of the evidence report. Nonbenzodiazepine muscle relaxants demonstrate effectiveness for acute low back pain and neck pain.4144 No single agent is superior; therefore, treatment decisions can be made based on the dosing schedule and patient preference.43 Sedation is a common adverse effect that can be mitigated by reducing the dose or limiting administration to the evening. They have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. For some patients a small improvement in pain or function using a treatment with low cost or no serious harms may be important. Here were answering your most pressing questions about acute pain. See permissionsforcopyrightquestions and/or permission requests. Muscle relaxants are effective adjunctive medications for acute low back pain and neck pain. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. The goals of acute pain management are to relieve suffering, facilitate function, enhance recovery, and satisfy patients. Publication bias will be assessed using funnel plots and statistical methods when there are at least 10 RCTs that can be combined in meta-analysis.50. There is ongoing controversy about the role of vertebral augmentation procedures, due to conflicting trial results. Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. We will provide a qualitative summary of our assessment. See Appendix A for Medline search strategies. It can serve as a warning of disease, illness, or traumatic event. Data Abstraction and Data Management: After studies are selected for inclusion, data from the studies will be entered into tables. LowWe have limited confidence that the estimate of effect lies close to the true effect for this outcome. How do harms vary depending on: (1) patient demographics (e.g. (random* or control* or trial or cohort or prospective or retrospective).ti,ab,kf,sh. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Selective COX-2 inhibitors (e.g., celecoxib [Celebrex]) have a significantly safer GI adverse effect profile but may be cost prohibitive. We will use information regarding these factors to assess the extent to which interventions and results are likely most relevant to real-world clinical practice in typical U.S. settings that include the Medicare population. Nonopioid therapy: Oral, parenteral, or topical nonopioid pharmacological therapy used for acute pain (acetaminophen, nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, benzodiazepines, antidepressants, anticonvulsants, cannabis). Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. An official website of the Department of Health & Human Services. How do the effectiveness and harms vary according to demographic (age, sex, race/ethnicity), clinical (type of pain, severity of pain, prior treatments, medical and psychiatric co-morbidities), and technical factors (variations in techniques, intensity, frequency, dose, and number of treatments)? This systematic review will assess the comparative effectiveness of treatments and harms of opioid and nonopioid treatments for surgical and nonsurgical pain related to eight acute pain conditions (back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain after discharge, dental pain, kidney stones, and sickle cell crisis). Nociceptive pain caused by tissue damage, such as fractured bones usually throbbing or sharp. Gentle range of motion exercises to see what movements trigger the pain. Intradiscal ozone injection. EPC core team members must disclose any financial conflicts of interest greater than $1,000 and any other relevant business or professional conflicts of interest. Medical-grade cannabis is effective for the treatment of chronic pain. 5600 Fishers Lane (scisearch or psychinfo or psycinfo).tw,sh. How do harms vary depending on: (1) patient demographics (e.g. Meta-analyses will be conducted to summarize data and obtain more precise estimates on outcomes for which studies are homogeneous enough to provide a meaningful combined estimate.46 The decision to conduct quantitative synthesis will depend on presence of at least two studies, completeness of reported outcomes and a lack of heterogeneity among the reported results. Patient uses pharmacological and nonpharmacological pain-relief strategies. Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions. This content is owned by the AAFP. The draft Key Questions and scope were developed by the Evidence-based Practice Center with input from the Agency for Healthcare Research and Quality (AHRQ) and CMS and was revised based on input from a Technical Expert Panel (TEP) prior to finalization. The final report does not necessarily represent the views of individual reviewers. The EPC considers all peer review comments on the draft report in preparing the final report. We believe that the findings are likely to be stable, but some doubt remains. age, gender); (2) patient medical comorbidities; (3) the type of nonopioid medication; (4) dose of medication; (5) the duration of therapy? All Rights Reserved. Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate (e.g., muscle relaxants may be useful for acute low back pain). Care Plan: Nursing Interventions for Acute Pain, NANDA A record of studies excluded at the full-text level with reasons for exclusion will be maintained. Pharmacologic pain management as ordered. Dual-action medications have been studied mostly in cancer-related or chronic pain but may be useful in acute pain when first-line agents are not effective, tolerated, or safe. For example, postoperative pain occurs at a specific point in time and is often managed with multimodal strategies in a monitored setting prior to discharge, whereas in outpatient clinic settings, timing of presentation is variable, and assessing treatment response is often not feasible. Opioid prescribing quadrupled from 1999 to 2010; concurrently, the number of opioid analgesic deaths and opioid use disorder (OUD) cases similarly rose sharply.9 In 2018, an estimated 46,802 Americans died from opioid overdose (approximately 15,000 from prescription opioids)both representing declines from 2017, but well above pre-2010 levels. Large/substantial effects are defined as greater than moderate. It also does not address interventional procedures conducted in the Medicare population that are covered by CMS, are recommended in clinical practice guidelines, and/or have been addressed in other recent and comprehensive systematic reviews (e.g., epidural steroid injection, perioperative peripheral and central regional anesthetic techniques, and spinal cord stimulation).32,34-39, All methods used for this systematic review will be conducting in accordance with AHRQs Methods Guide for Effectiveness and Comparative Effectiveness Review, developed for the Evidence-based Practice Centers.40. (comment or editorial or meta-analysis or practice-guideline or review or letter).pt. Each Key Question (KQ) for this review focuses on a specific acute pain condition. Rockville, MD 20857 In older adults, management of pain is often complicated by medical comorbidities, polypharmacy, increased susceptibility to treatment harms, and assessment challenges due to impaired cognition, often resulting in untreated or under treatment of pain.5,6. For each condition above, we will address the following subquestions: Adults with acute pain related to the following conditions: ae. Direct financial conflicts of interest that cumulatively total more than $1,000 will usually disqualify an EPC core team investigator. Any disagreements will be resolved by consensus. The strength of evidence for comparison-outcome pairs within each KQ will be initially assessed by one researcher for each clinical outcome (see PICOTS) by using the approach described in the Methods Guide for Effectiveness and Comparative Effectiveness Review.40 To ensure consistency and validity of the evaluation, the initial assessment will be independently reviewed by at least one other experienced investigator using the following criteria; disagreements will be resolved by consensus: The strength of evidence will be assigned an overall grade of high, moderate, low, or insufficient according to a four-level scale by evaluating and weighing the combined results of the above domains. Because of their unique clinical or content expertise, individuals are invited to serve as Technical Experts and those who present with potential conflicts may be retained. The criteria for inclusion and exclusion of studies will be based on the Key Questions and are described in the previous PICOTS section. Search dates: February 4, 2020, to August 1, 2020. Opioids, traditionally considered the most potent analgesic, are frequently prescribed for acute or chronic pain, including in older adults and those with disabilities.4,7,8 Therefore, pain management must be considered within the context of the current opioid crisis. Adults with pain of any duration (pain conditions for each interventional procedure specified below); will highlight studies of populations applicable to Medicare, defined as persons enrolled in Medicare, age >55 years, or persons with disability (including end-stage renal disease [ESRD]), if available, Population subgroups of interest include those based on demographics (age, sex, race/ethnicity) and clinical factors (type of pain, severity of pain, prior treatments, medical and psychiatric co-morbidities, including presence of disability [including ESRD], prior substance use disorder, and psychological co-morbidities). Analgesics may be administered into the surgical site, or nerves to the site may be kept blocked in the initial postoperative phase. This meta-analysis was conducted to fill that gap. Based on the risk of bias assessment, individual included studies will be rated as being "good,""fair,"or "poor" quality as described below: Data Synthesis: Data will be qualitatively summarized in tables, using ranges and descriptive analysis and interpretation of the results. (meta-analys$ or meta analys$ or metaanalys$).tw,sh. Traditionally, opioid analgesic therapy has served as the mainstay of treatment for acute postoperative pain. How do harms vary depending on: (1) patient demographics (e.g., age, gender); (2) patient medical or psychiatric comorbidities; (3) the dose of opioid used; (4) the duration of opioid therapy; (5) opioid use history; or (6) substance use history? Technical factors of interest as potential modifiers of treatment effect include variations in techniques, intensity, frequency, dose, or number of treatments. If any pertinent new literature is identified for inclusion in the report, it will be incorporated before the final submission of the report. How does effectiveness of nonopioid pharmacologic therapy vary depending on: (1) patient demographics (e.g. Similarly, trials that use active run-in periods evaluate highly selected populations who tolerated and responded well to the study intervention, rather than the general population of acute pain patients being considered for the intervention. Describes the level of certainty of the estimate of effect for a particular outcome with a precise estimate being on that allows a clinically useful conclusion. Neuropathic pain caused by nerve damage can happen after surgery difficult to treat compared to other types of pain. Topical NSAIDs are recommended for non-low. Acute pain is ubiquitous following surgery.5 Pain is the most common reason for emergency department visits and is commonly encountered in primary care, other outpatient, and inpatient settings.2,6,7. This procedure is performed for trigeminal neuralgia, migraine headaches, cluster headaches, and other headache syndrome. Peer reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. Carbonated drinks and gas-producing foods. Supplementing Searches: A Supplemental Evidence And Data for Systematic review (SEADS) portal will be available, and a Federal Register Notice will be posted for this review. Topical nonsteroidal anti-inflammatory drugs are safe and effective for treating acute pain. Key Questions on nonopioid therapies include comparisons against sham, waitlist, usual care, attention control, and no therapy due to greater uncertainty regarding their role in management of acute pain. No evidence is available, or the body of evidence has unacceptable deficiencies, precluding reaching a conclusion. Should Muscle Relaxants Be Used as Adjuvants in Patients With Acute Low Back Pain? Sensitivity and subgroup analyses, including meta-regression, will be performed to explore statistical heterogeneity and differences by study quality, intervention differences, patient characteristics, and outcome measurement, data permitting (e.g. Although acute pain usually resolves rapidly, in some cases it can persist to become chronic. Some examples include: a burn, cut, or broken bone. It is the leading cause of disability in the United States and often difficult to treat. (((back or spine or spinal or vertebral or leg or musculoskeletal or neuropathic or nociceptive or radicular) adj1 pain) or headache or arthritis or fibromyalgia or osteoarthritis or neuralgia or neuropath*).ti,ab,kw. Each full-text article will be independently reviewed for eligibility by two team members. Pain Management (Cheat Sheet) Example Care Plan_Acute Pain (Cheat Sheet) Pain Assessment Questions (Mnemonic) Pain Assessment (Picmonic) Outline Pathophysiology Acute pain is a sudden type of pain that typically lasts less than 3-6 months. Divergent and conflicting opinions are common and perceived as healthy scientific discourse that fosters a thoughtful, relevant systematic review. (pooling or pooled or mantel haenszel).tw,sh. Vital signs before medication and after medication as per institutional policy. Recent data suggest an association between use of opioids for acute pain and persistent long-term use, with some evidence of a dose and duration-response relationship.19-25 In addition, some studies indicate that opioids may not be more effective than nonopioid therapies for some acute pain conditions,26-30 and use of opioids may negatively affect recovery and function.31,32 Opioids prescribed for surgery and other acute pain conditions often go unused, a potential source for diversion and misuse.33-35 The 2016 Centers for Disease Control and Prevention (CDC) guideline focused on chronic pain, but included one recommendation to limit opioids for acute pain in most cases to 3 to 7 days. It involves electrical stimulation of the occipital nerve. https://www.cdc.gov/drugoverdose/pdmp/states.html, Systematic review, consistent randomized controlled trials, evidence-based guidelines, Systematic reviews, consistent randomized controlled trials, clinical guidelines, Systematic review, multiple randomized controlled trials, Meta-analysis (gabapentinoids), systematic review (gabapentinoids and antidepressants), mixed results from high-quality studies (gabapentinoids), Expert consensus opinion, clinical guidelines, Orally or rectally: 325 to 1,000 mg every 4 to 6 hours, Ibuprofen: 200 to 400 mg every 6 to 8 hours, Naproxen: 250 mg every 6 to 8 hours or 500 mg every 12 hours, Celecoxib (Celebrex): 100 to 200 mg per day, Combinations have superior effectiveness vs. single agents, Hydrocodone/acetaminophen: 2.5 mg/325 mg to 10 mg/325 mg every 4 to 6 hours, Superior effectiveness compared with single agent, Hydrocodone/ibuprofen: 2.5 mg/200 mg to 10 mg/ 200 mg every 6 to 8 hours, Oxycodone/acetaminophen 2.5 mg/325 mg to 10 mg/ 325 mg every 4 to 6 hours, Tramadol (Ultram): 25 mg every 4 to 6 hours, titrated to 50 to 100 mg as needed, Pain refractory to other agents, with goal of limiting more potent opioids, Adverse effects comparable to full agonists with less pain relief, Tapentadol (Nucynta): 50 to 100 mg every 4 to 6 hours, Oxycodone: 5 mg orally every 4 to 6 hours as needed, Morphine: 1 to 4 mg IV every 4 hours titrated up as needed; 10 to 15 mg IV every 4 to 6 hours for severe pain, Apply 2 to 4 g to skin over painful area 3 to 4 times per day for up to 7 days, Topical NSAID that relieves pain associated with acute, localized, joint or muscle injuries in patients 16 years (1%) or 18 years (3%) of age, Apply 1 patch over painful area 1 to 2 times per day, Topical NSAID with relief of pain due to acute musculoskeletal strains and sprains, and contusions in adults and children 6 years, Apply 0.5 g to the forehead and temples 2 to 4 times per day for no more than 7 days, Alternative combination treatment for relief of acute headache and muscle pains.
412 W Tahquitz Canyon Way, Palm Springs, Ca 92262,
Michigan Independent Newspaper,
Articles I
