Pain - analgesia overview for pain
The most effective approach to managing pain is considered to be the use of several different types of analgesics together. This is known as multimodal analgesia.
Introduction
The most effective approach to managing pain is considered to be the use of several different types of analgesics together. This is known as multimodal analgesia.
Using a combination of drugs such as paracetamol, a non-steroidal anti-inflammatory drug and an opiate provides more effective pain relief as the different analgesic drugs affect different parts of the pain pathway. This can increase efficacy while minimizing the dose and therefore the potential for side effects of each drug.
Analgesic Guidelines
The following information outlines the main analgesics used at Starship Child Health. The dosing regimens, preparations and considerations for each medicine are outlined.
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Routes of Administration
Oral route should be the preferred route of administration, however, majority of the analgesics can be given via alternative routes if oral is not an option. Details of administration routes can be found in the analgesic guidelines above.
Paracetamol
Paracetamol is an antipyretic as well as an analgesic but it has no significant anti-inflammatory effect. The action is mainly in the central nervous system. It is useful for mild pain.
Paracetamol must be charted as IV or PO or PR. It cannot be charted IV/PO/PR due to different dosing restrictions for each administration route.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs act mainly at the peripheral nervous system by interfering with the chemicals that sensitise the nerve endings to the pain. They have anti-inflammatory, antipyretic and analgesic properties. These drugs include ibuprofen and diclofenac.
They are effective for mild to moderate pain.
Atypical Opioids (Tramadol)
Act mainly in the brain and spinal cord by inhibiting the transmission of pain impulses. They are powerful analgesics but tend to have a 'ceiling effect' and are less addictive than opioids. Effective for moderate pain.
See Tramadol: advice on the use in New Zealand Children for further information on tramadol use in children and prescribing recommendations.
Opioids (Morphine and Oxycodone)
Act mainly in the brain and spinal cord by inhibiting the transmission of pain impulses. They are powerful analgesics.
These are effective for severe pain.
Three step strategy for pain management
| Step 1 (mild pain) | Paracetamol and/or NSAID (if not contraindicated) |
|---|---|
| Step 2 (mild to moderate pain) | Paracetamol and/or NSAID (if not contraindicated) and tramadol (atypical opioid) |
| Step 3 (moderate to severe pain) | Paracetamol and/or NSAID (if not contraindicated) and opioid |