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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, May 15, 2015


"6 Tips to Improve on your Next Shift:

The most common issue with pain management in the Emergency Department is the under treatment of pain.
  • This is known as "oligoanalgesia"
  • Be prepared to diagnose and treat oligoanalgesia when you see it.
(2) Most healthcare providers “do not titrate opiods to what the patient wishes"; rather, they titrate – if they titrate at all – to either a pain score that in their minds is ‘low enough’or to a set amount of medication they feel is safe or sufficient“.
  • To optimise pain control communicate your ‘end points’ and titrate the medications. 
  • Accurate assessment and documentation of initial pain rating is important.
(3) On your next shift ask your patient: “Sir, would you like more pain medicine?”
(4) We are bad at rating pain.
  • There even appears to be ethnic discrimination.
  • Junior doctors have been shown prescribe more and rate patient´s pain more accurately than senior colleagues
“Evaluation of this pain should be with use of objective pain scales 
completed by the patient, not relying on physician impression.“

(5) In the context of acute pain there is minimal evidence that patients will get addicted to opioid analgesics…
(6) Select the most suitable analgesics at the right dose, frequency and administration route. Certain analgesics are known to be ineffective – follow the best evidence from studies and local experts
  • Not all patients metabolise codeine to morphine so it may not be effective in up to 10% of patients
  • Patients on high doses of regular opioids (e.g. patients with malignancy) with ‘breakthrough’ pain should be given doses opioid analgesia at 1/6 of their total daily dose
  • Generally avoid Tramadol"