Category: Adult Analgesia

Opioid Administration and Severe Pain

Question:

For the Analgesia medical directive. For Morphine and Fentanyl, patient need to be in severe pain. The only place I can find the definition of severe pain is in the cardiac ischemia protocol were they stated severe pain is equal or greater than 7/10. I assume that severe pain for analgesia will be the same. Now this is my question. If I attend to a patient with a hip fracture with pain 10/10 with normal vitals and gave the patient 5mg and the pain goes down to 3/10 I have to wait until the patient pain goes back to 7/10 or greater before I can gave more Morphine. I always thought that the best treatment for my patient will be when you are able to reach a therapeutic level for pain control that you will try to keep it there, by administering smaller those when the pain start to increase again and keep the patient comfortable. And not wait until the pain become out of control again. Thanks

Answer:

We recommend obtaining and documenting an initial quantitative/qualitative pain score to guide appropriate interventions for pain management. As you manage acute pain using non-pharmacological interventions and therapeutic communication, note if the severe pain remains. If it does, opioids may be considered for pharmacological approach to pain management (you can consider a combination of pharmacological interventions if appropriate).

After the initial quantitative or qualitative has been obtained, the goal is to tailor opioid administration to the patient’s needs and therapeutic level of pain control while taking into account different risk factors that can influence the desired therapeutic effect.

You do not need to wait for the pain to reach a “severe” level again before administering more doses of morphine or fentanyl.

Please ensure initial pain score, clinical picture, non-pharmacological interventions, pharmacological interventions and reassessments are documented.

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