Developing an Effective Oral Analgesic Regimen. Theresa Kristopaitis, MD Department of Internal Medicine, Division of General Medicine Associate Medical Director, Loyola Hospice. General Principles. Assess pain thoroughly Know your patient Know the medications
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Theresa Kristopaitis, MD
Department of Internal Medicine, Division of General Medicine
Associate Medical Director, Loyola Hospice
Neuroscience lectures on pain physiology!
P&T lectures on NSAIDs and opiates!
Nociceptive pain – results from actual or potential tissue damage. Result
of ongoing activation of nociceptors on primary afferent nerves by
Somative vs visceral
Step 3 - Severe
Step 2 - Moderate
Step 1 - Mild
Always consider adding an adjuvant Rx
Hospice and Palliative Care Training for Physicians: UNIPAC 3
Assessment and Treatment of Physical Pain Associated with Life-
Limiting Illness, CP Storey et al, ed
EPERC, Fast Facts
“Who’s got the narc keys?”
“Who’s got the opioid keys?”
-50 different opioid combination products
(acetaminophen 3900mg/24 hours)
In opiate naïve patients!!!!!
-Crosses skin and oral mucosa
po / pr (mg) Analgesic SC / IV / IM (mg)
100 Codeine 60
15 Hydrocodone -
4 Hydromorphone 1.5
15 Morphine 5
10 Oxycodone -
=180mg morphine equivalent
Fentanyl 75mcg/hr patch q 72 hrs