Pain Meds

Acute Pain

Pain associated with an immediate cause

Chronic Pain

Pain persisting for 3 months or longer.

Neuropathic pain

pain caused by disease or damage to the nerve

Nociceptive Pain

pain resulting from stimuli such as temperature, pressure, inflammation, trauma, and chemical agents

Radicular pain

pain associated with entrapped or compressed spinal nerve

Opioid Agonists

treats moderate to severe pain, induce sedation, and lessen anxiety.

Examples: Morphine, Fentanyl, Hydromorphone, Methadone

Opioid Agonists-Antagonists

Treats moderate to severe pain and is used as an adjunct to anesthesia

Not as effective as opioid agonists at controlling pain

Example: Butorphanol

Opioids-2

Mechanism of action: bind with mu receptor at opioid receptors to inhibit

activity in the pain signaling pathways

• Indications for use: severe pain and sedation

• Contraindications: altered level of consciousness, bowel obstruction,

respiratory depression, history of opioid use disorder, pregnancy

• Side/Adverse Effects: nausea, vomiting, constipation, euphoria, respiratory

depression

• Patient Education: manage bowel function, avoid combining with other CNS

depressants, high risk for dependency

Opioids Antagonists

Example: Naloxone

• Mechanism of action: bind to opioid receptors and prevent opioid agonists

from exerting their effects

• Effects on body: rapid reversal of opioid intoxication, GI hypermotility

• Indications for use: reversing opioid toxicity, prevention of alcohol and opioid

dependence, opioid induced constipation

• Contraindications: acute opioid withdrawal

• Side/Adverse Effects: n/v/d, aggression, arrhythmias

• Patient Education: watch for withdrawal manifestations

Nonopioid Analgesics

Example: Acetaminophen

• Mechanism of action: Interrupts prostaglandin production

• Indications for use: Treat and reduce mild pain and fever

• Contraindications: Avoid with alcohol use disorder or liver disease

• Side/Adverse Effects: GI upset, itching, liver damage

• Patient Education: Avoid over-consumption, avoid using alcohol

Nonopioid Analgesics: NSAIDS

Example: Aspirin and Ibuprofen

• Mechanism of action: Blocks COX enzymes

• Indications for use: suppresses inflammatory conditions, treats moderate pain

and fever

• Contraindications: peptic ulcer disease, recent or pending surgery, liver or

kidney disease

• Side/Adverse Effects: GI effects, headache, renal dysfunction, heart failure,

shortness of breath, anaphylaxis

• Patient Education: Avoid over-consumption, do not use in combination with

other NSAIDs, take with food or milk

Nonopioid Analgesics: Local Anesthetics

Example: Lidocaine

• Mechanism of action: blocks ion transport across neuronal membranes

• Effects on body: loss of sensation

• Indications for use: local numbing for a procedure, minor burns

• Contraindications: broken skin, cardiovascular disease

• Side/Adverse Effects: skin irritation, toxicity

• Patient Education: Avoid use on open skin, use only as prescribed

General Anesthesia: Sedative-Hypnotics

• Examples: Propofol, etomidate, ketamine

• Indications for use: General anesthesia. Propofol is an anticonvulsant.

Ketamine is a bronchodilator and has pain relieving properties.

• Contraindications: Propofol, egg or soy allergy; etomidate those who are

chronically ill; Ketamine, children and history of schizophrenia

• Side/Adverse Effects: amnesia, respiratory depression, hypotension,

laryngospasm

General Anesthesia: Synthetic Opioids

Example: Fentanyl

• Indications for use: suppressing airway reflexes (intubation), reducing pain

• Contraindications: use of MAOIs

• Side/Adverse Effects: sedation, respiratory depression, euphoria, muscle

rigidity, cardiovascular depression, hypotension, crosses placenta

General Anesthesia: Benzodiazepines

Example: Alprazolam, diazepam, lorazepam, clonazepam

• Indications for use: relieve anxiety, moderate sedation

• Contraindications: glaucoma, hypotension, impaired renal or hepatic function,

pregnancy

• Side/Adverse Effects: vomiting, apnea, delirium, respiratory depression

General Anesthesia: Neuromuscular Blocking Agents

Example: succinylcholine (depolarizing)

• Indications for use: Rapid sequence intubation and short procedures

• Contraindications: hyperkalemia, neuromuscular disorders

• Side/Adverse Effects: hyperkalemia, malignant hyperthermia, prolonged

paralysis

• Education: Give with a sedating medication

Muscle Relaxants: Peripherally Acting

Example: Dantrolene

• Mechanism of action: decreases the muscles’ force of contraction

• Indications for use: spasticity

• Contraindications: liver disease, CCB, CNS depressants

• Side/Adverse Effects: CNS depression, liver toxicity, generalized muscle

weakness

Alpha 2 Adrenergic (Centrally acting muscle relaxants)

Examples: Tizanidine

• Indications for use: reduce spasticity and increase muscle flexibility.

Contraindications: liver impairment

• Side/Adverse Effects: drowsiness, hypotension, sedation, weakness, urinary frequency

Gaba Mimetics (Centrally Acting Muscle Relaxants)

Examples: Baclofen

• Indications for use: reversible spasticity

• Contraindications: MAOI use, mental health history, seizure disorder, prior stroke

• Side/Adverse Effects: Drowsiness, fatigue, muscle weakness

• Patient education: stopping medication abruptly, can worsen spasticity in muscle damage.