Joshua Vanderloo PharmD, RPh Clinical Pharmacist, University of Wisconsin Hospital and Clinics. Pain Management in the hospitalized patient. Disclosures. I have no actual or potential conflict of interest in relation to this presentation. . Objectives.
Or: Framing the Discussion
*HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems
1National Institute of Neurological Disorders and Stroke. Peptides implicated in body’s response to pain.
2Postoperative pain management: a practical review, part 2. Am J Health-Syst Pharm. 2005; 62:2019-2025.
3Economic benefits of an acute interventional postoperative pain service. Anesth analg. 2007;104:S-75.
Acute pain chronic pain syndromes
Cervero F. Pain. 1996
Gottschalk A, Smith DS. Am Fam Physician. 2001
1. Initial pain: Nonopioids
mild opioid or strong opioid with titration if pain inadequately managed
treatments for fear/anxiety if needed
3. Schedule medications instead of PRN – “around the clock”
Right drug, right dose, right time 80-90% effective and cost effective
World Health Organization (2009). WHO’s Pain Relief Ladder. http://www.who.int/cancer/palliative/painladder/en/
Analgesic chosen according to intensity
Vargas-Schaffer G. Can Fam Physician. 2010.
ACG Guidelines. Am J Gastroenterol. 2009;104:728-738.
NSAID prescribing precautions. Am Fam Physician. 2009;80:1371-1378.
Nausea and vomiting
Less frequent: Opioid-induced Hyperalgesia, urinary retention, delirium, myoclonus