About Pain Analgesic Flowchart

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Use this flow chart(algorithm) for online advice about using pain relief medication for conditions
like back pain, period pain, toothache and arthritis !ost of the medicines mentioned in this
analgesic ladder can be bought over the counter (paracetamol, the anti"inflammator# ibuprofen,
cocodamol $%&'')
(f #ou re)uire strong narcotic prescription pain relieving drugs, #ou will need to make an
appointment with #our famil# doctor
*et #our mouse hover some of the drug names for simple analgesic dosing recommendations (route
of administration, dose, fre)uenc# etc)
+ate #our pain as !ild, !oderate or ,evere, and choose the correct starting place in the left hand
column
Pain nalgesic d!ice Comments
Mild
,tart with regular
paracetamol
,ee Pain -#pes and !edication -#pes for advice
about which analgesics are best for particular t#pes
of pain

Change to regular
paracetamol plus an .,A(/
(eg ibuprofen)
0e aware of the side effects and contra"indications
of .,A(/s

Moderate
Change to regular cocodamol
$%&'' plus an .,A(/ (eg
ibuprofen)
0e aware of the side effects and contra"indications
of .,A(/s, and codeine All these medications can
be bought over the counter at #our local pharmac#
Alwa#s read the instruction leaflet about dose and
fre)uenc# (f #ou are taking an# other medication
from #our doctor or #ou are pregnant, please ask
#our pharmacist or 1P for further advice

,ee #our doctor to change to
regular cocodamol 2'%&''
plus an .,A(/ (eg
34 of the population can5t convert codeine to
morphine in the liver, making codeine totall#

6olland 7 0arrett
Offer " &'4
savings on
8itamins,
!inerals 7
supplements

Pharmac# 9U
Offer " F+::
deliver# on all U;
non"prescription
orders over <=&
6ealth# /irect
Offer " >'4 off
orders over <>'
(code 6/A"./:
ends 2>>9'?)



ibuprofen) ineffective for them Consider -ramadol %
0uprenorphine % !orphine instead

,ee #our doctor to change to
regular paracetamol plus an
.,A(/ (eg ibuprofen) plus
either dih#drocodeine O+
tramadol
/ih#drocodeine and -ramadol are both available in
normal release and slow release preparations

"e!ere
,ee #our doctor to change to
regular paracetamol plus an
.,A(/ (eg ibuprofen) plus
oral morphine (>' mg =
hourl#)
(f #ou have nerve t#pe pain, see #our doctor about
medications specific for that t#pe of pain (see Anti"
depressants, Anti"convulsants, .erve Pain)

Calculate the 9= hour dose of
morphine and convert if
necessar# to twice dail# slow
release oral morphine (!,-)
Use normal release morphine
= hourl# for breakthrough
pain (single dose @ >%Ath
total dail# dose)
(f necessar# the dail#
morphine dose can be
increased b# &'">''4 as
smaller dose increases ma#
not produce an# clinicall#
noticeable effect
Alternatives to morphine include oB#codone,
h#dromorphone, fentan#l patches, and
buprenorphine (patches and sublinguall#) Avoid
oral pethidine as it onl# lasts >& hours
+emember that morphine (and an# other
morphine"like drug) causes constipation -he best
cure for this is lactulose (for lubrication) plus
senna (for movement)
.ausea and vomiting can be troublesome initiall#
but usuall# passes with acclimatisation (f #ou are
activel# vomiting then anti"emetics b# mouth will
be ineffective ,ome anti"emetics are available
sublinguall# or b# suppositor# and can therefore
b#pass this problem
Consider Pain Clinic referral for specific non"drug
interventions eg nerve blocks, epidural inCections,
Coint inCections etc
Co#yright $c% &''( )))*PainClinic*org
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