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Analgesia

Updated : December 19, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

remifentanil 

Indicated for Post-Operative Period :

0.025-0.2 mcg/kg per minute IV



acetaminophen/pamabrom/pyrilamine 

Indicated for Menstrual Cramps :


1-2 capsule/tablet/gelcap orally 4 times a day



acetaminophen/pamabrom 

Indicated for menstrual cramps:


1-2 caplets orally every 4-6 hours whenever necessary. Do not exceed eight caplets for 24 hours



methylsalicylate/menthol/camphor topical 

Indicated for Analgesia for Minor Joint/ Muscle Pain:


Apply generous amounts topically and massage the affected region
Apply the patch to the affected area



turmeric 

For topical
Obtain standardized curcumin extract to 95%



trolamine salicylate 

Indicated for Analgesia for Minor Muscle/Joint Pain:


Apply a generous volume topically and massage the affected region three or four times daily



acetaminophen rectal 

Indicated for Analgesic/Antipyretic
:


325 to 650mg per rectum every 4 to 6 hours whenever necessary
Do not exceed 4g/day



menthol topical 

Indicated for Analgesia for Minor Joint/Muscle Pain:


Apply a thick layer of the cream or gel and massage it into the affected region.
Apply a patch to the affected area twice a day.



methylsalicylate/menthol topical 


Indicated for Analgesia for Joint Pain or Minor Muscle
A transdermal patch (10% of methylsalicylate /3% of menthol): Apply one patch near the affected area, and leave it in place for nearly 8-12 hours; it should not exceed one patch for application if needed can; apply a 2nd patch for 8-12 hours, it should not exceed two patches for one/three days of use
A transdermal patch (10% of methylsalicylate /1.5% of menthol): Apply one patch near the affected area; it should not exceed three-four times a day, and leave in a place not more than 8 hours
Cream/ Balm/ foam /spray/ stick: Apply a small amount topically near the affected area and gently massage



acetaminophen 

Indicated for Fever and Analgesia
:


Immediate release
Regular strength: Administer 325 to 650 mg orally or rectally every 4 hours whenever needed
Do not exceed 3250mg/day
4g/day of daily dose can be used

Extra strength: Administer 1000mg orally three or four times a day whenever needed
Do not exceed 3000mg/day
4g/day of daily dose can be used

Extended-release
Administer two capsules (each capsule-650mg) thrice a day whenever needed
Do not exceed 3.9g/day

Maximum dose
Acetaminophen products-Do not exceed a total of 3.25g/day of acetaminophen
4g/day of daily dose can be used
Tylenol Extra Strength (Each tablet or capsule-500mg)-Do not exceed 3g/day
4g/day of daily dose can be used



Dose Adjustments

Hepatic impairment:
Do not exceed 3g/day,
Caution is needed

Renal impairment:
GFR≥50ml/min-Dosage adjustment is not needed
GFR 10 to 50ml/min-Administer for every 6 hours

GFR <10ml/min-Administer for every 8 hours
Renal replacement treatment- Administer every 6 hours

acetaminophen/pamabrom/pyridoxine 

Indicated for the pain and cramps associated with menstruation
1 capsule orally every 4-6 hours as required



acetaminophen and phenyltoloxamine 

1 to 2 tablets or capsules orally every 4-6 times a day when necessary
Products differ; see the brand section and verify the specific labelling for each



pethidine 

obstetric :

50 to 100 mg Intramuscular or Subcutaneous injection, can be repeated every 1-3 hours as required. Maximum: 400 mg daily



Dose Adjustments

Dosing modifications:
Renal impairment
Mild-moderate: Dose reduction may be necessary.
Severe: use is Contraindicated
Hepatic impairment
Mild-moderate: Dose reduction may be necessary. Severe: use is Contraindicated

 

acetaminophen/pamabrom 

Indicated for menstrual cramps:


<12 years: Safety and efficacy not established
>12 years: 1-2 caplets orally every 4-6 hours whenever necessary. Do not exceed 8 caplets for 24 hours



lidocaine/tetracaine 

Local Dermal Analgesia
Superficial dermatologic treatments
<3 years: Safety and Efficacy not established
>3 years: Patch- Before the treatment, apply the patch to healthy skin for 30 minutes

IV cannulation or Venipuncture
<3 years: Safety and Efficacy not established
>3 years: Patch- Before the treatment, apply the patch to healthy skin for 30 minutes



trolamine salicylate 

Indicated for Analgesia for Minor Muscle/Joint Pain:


<2 years: Safety and efficacy not established
>2 years: Apply a generous volume topically and massage the affected region three or four times daily



acetaminophen rectal 

Indicated for analgesic/antipyretic:


>12 years: 325 to 650mg per rectum every 4 to 6 hours whenever necessary
6 to 12 years: 325 mg per rectum every 4 to 6 hours whenever necessary
3 to 6 years: 120 mg per rectum every 4 to 6 hours whenever necessary
1 to 3 years: 80 mg per rectum every 4 hours whenever necessary
3 months to 1 year: 80 mg per rectum every 6 hours whenever necessary

Maximum daily dose
≥12 years: Do not exceed 4g/day
<12 years: Do not exceed 5 doses for 24 hours



methylsalicylate/menthol topical 


Indicated for Analgesia for Joint Pain or Minor Muscle
Age >12 years
A transdermal patch (10% of methylsalicylate /3% of menthol): Apply one patch near the affected area, and leave it in place for nearly 8-12 hours; it should not exceed one patch for application if needed can; apply a 2nd patch for 8-12 hours, it should not exceed two patches for one/three days of use
A transdermal patch (10% of methylsalicylate /1.5% of menthol): Apply one patch near the affected area; it should not exceed three-four times a day, and leave in a place not more than 8 hours
Cream/ Balm/ foam /spray/ stick: Apply a small amount topically near the affected area and gently massage
Age <12 years
Safety and efficacy not established



tolmetin 

20-28 mg/kg/day orally divided every 6 hours
Administration
Take with 8-to-12-ounce water to ignore gastro-intestinal effects



 

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References

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Analgesia

Updated : December 19, 2022




remifentanil 

Indicated for Post-Operative Period :

0.025-0.2 mcg/kg per minute IV



acetaminophen/pamabrom/pyrilamine 

Indicated for Menstrual Cramps :


1-2 capsule/tablet/gelcap orally 4 times a day



acetaminophen/pamabrom 

Indicated for menstrual cramps:


1-2 caplets orally every 4-6 hours whenever necessary. Do not exceed eight caplets for 24 hours



methylsalicylate/menthol/camphor topical 

Indicated for Analgesia for Minor Joint/ Muscle Pain:


Apply generous amounts topically and massage the affected region
Apply the patch to the affected area



turmeric 

For topical
Obtain standardized curcumin extract to 95%



trolamine salicylate 

Indicated for Analgesia for Minor Muscle/Joint Pain:


Apply a generous volume topically and massage the affected region three or four times daily



acetaminophen rectal 

Indicated for Analgesic/Antipyretic
:


325 to 650mg per rectum every 4 to 6 hours whenever necessary
Do not exceed 4g/day



menthol topical 

Indicated for Analgesia for Minor Joint/Muscle Pain:


Apply a thick layer of the cream or gel and massage it into the affected region.
Apply a patch to the affected area twice a day.



methylsalicylate/menthol topical 


Indicated for Analgesia for Joint Pain or Minor Muscle
A transdermal patch (10% of methylsalicylate /3% of menthol): Apply one patch near the affected area, and leave it in place for nearly 8-12 hours; it should not exceed one patch for application if needed can; apply a 2nd patch for 8-12 hours, it should not exceed two patches for one/three days of use
A transdermal patch (10% of methylsalicylate /1.5% of menthol): Apply one patch near the affected area; it should not exceed three-four times a day, and leave in a place not more than 8 hours
Cream/ Balm/ foam /spray/ stick: Apply a small amount topically near the affected area and gently massage



acetaminophen 

Indicated for Fever and Analgesia
:


Immediate release
Regular strength: Administer 325 to 650 mg orally or rectally every 4 hours whenever needed
Do not exceed 3250mg/day
4g/day of daily dose can be used

Extra strength: Administer 1000mg orally three or four times a day whenever needed
Do not exceed 3000mg/day
4g/day of daily dose can be used

Extended-release
Administer two capsules (each capsule-650mg) thrice a day whenever needed
Do not exceed 3.9g/day

Maximum dose
Acetaminophen products-Do not exceed a total of 3.25g/day of acetaminophen
4g/day of daily dose can be used
Tylenol Extra Strength (Each tablet or capsule-500mg)-Do not exceed 3g/day
4g/day of daily dose can be used



Dose Adjustments

Hepatic impairment:
Do not exceed 3g/day,
Caution is needed

Renal impairment:
GFR≥50ml/min-Dosage adjustment is not needed
GFR 10 to 50ml/min-Administer for every 6 hours

GFR <10ml/min-Administer for every 8 hours
Renal replacement treatment- Administer every 6 hours

acetaminophen/pamabrom/pyridoxine 

Indicated for the pain and cramps associated with menstruation
1 capsule orally every 4-6 hours as required



acetaminophen and phenyltoloxamine 

1 to 2 tablets or capsules orally every 4-6 times a day when necessary
Products differ; see the brand section and verify the specific labelling for each



pethidine 

obstetric :

50 to 100 mg Intramuscular or Subcutaneous injection, can be repeated every 1-3 hours as required. Maximum: 400 mg daily



Dose Adjustments

Dosing modifications:
Renal impairment
Mild-moderate: Dose reduction may be necessary.
Severe: use is Contraindicated
Hepatic impairment
Mild-moderate: Dose reduction may be necessary. Severe: use is Contraindicated

acetaminophen/pamabrom 

Indicated for menstrual cramps:


<12 years: Safety and efficacy not established
>12 years: 1-2 caplets orally every 4-6 hours whenever necessary. Do not exceed 8 caplets for 24 hours



lidocaine/tetracaine 

Local Dermal Analgesia
Superficial dermatologic treatments
<3 years: Safety and Efficacy not established
>3 years: Patch- Before the treatment, apply the patch to healthy skin for 30 minutes

IV cannulation or Venipuncture
<3 years: Safety and Efficacy not established
>3 years: Patch- Before the treatment, apply the patch to healthy skin for 30 minutes



trolamine salicylate 

Indicated for Analgesia for Minor Muscle/Joint Pain:


<2 years: Safety and efficacy not established
>2 years: Apply a generous volume topically and massage the affected region three or four times daily



acetaminophen rectal 

Indicated for analgesic/antipyretic:


>12 years: 325 to 650mg per rectum every 4 to 6 hours whenever necessary
6 to 12 years: 325 mg per rectum every 4 to 6 hours whenever necessary
3 to 6 years: 120 mg per rectum every 4 to 6 hours whenever necessary
1 to 3 years: 80 mg per rectum every 4 hours whenever necessary
3 months to 1 year: 80 mg per rectum every 6 hours whenever necessary

Maximum daily dose
≥12 years: Do not exceed 4g/day
<12 years: Do not exceed 5 doses for 24 hours



methylsalicylate/menthol topical 


Indicated for Analgesia for Joint Pain or Minor Muscle
Age >12 years
A transdermal patch (10% of methylsalicylate /3% of menthol): Apply one patch near the affected area, and leave it in place for nearly 8-12 hours; it should not exceed one patch for application if needed can; apply a 2nd patch for 8-12 hours, it should not exceed two patches for one/three days of use
A transdermal patch (10% of methylsalicylate /1.5% of menthol): Apply one patch near the affected area; it should not exceed three-four times a day, and leave in a place not more than 8 hours
Cream/ Balm/ foam /spray/ stick: Apply a small amount topically near the affected area and gently massage
Age <12 years
Safety and efficacy not established



tolmetin 

20-28 mg/kg/day orally divided every 6 hours
Administration
Take with 8-to-12-ounce water to ignore gastro-intestinal effects



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