Opioid Settings

If the patient is to be managed as an outpatient, weak opiates are often utilized. These medications are often prescribed on an as needed basis or in chronic states and are administered around the clock. Patients can be instructed to alternate acetaminophen-containing opiates with non-steroidal anti-inflammatory drugs in order to reduce acetaminophen-related potential injury to the liver. Currently, no more than 4 g of acetaminophen is recommended to be consumed in a 24-h period. In some countries outside of the United States, acetaminophen is deemed so toxic that it is not sold or used in clinical practice.

More options exist in managing patients with acute pain in the hospital setting. If a patient is able to tolerate oral intake, then weak opiates in elixir or tablet form are often prescribed as first-line therapy with mild and even moderate pain states. Patients taking opiates prior to their hospitalization should be maintained on their home regimen and also receive additional medications for acute pain. Home medications or first-line weak opiates can be given as scheduled around the clock doses as mentioned above, with strong opiates reserved for breakthrough pain on an as needed basis. Patients with severe pain and severe chronic pain states may need strong opiates on a 24-h/day regimen. Having scheduled doses available to treat patients can relieve anxiety, provide some level of control for the patient, and help to avoid unnecessary suffering. Delays in administration of doses often lead to subtherapeutic plasma concentrations of the drug and continued pain states. To avoid such complications, an increasing number of facilities employ patient-controlled analgesia (PCA) in both parenteral and neuraxial preparations. Another advantage of PCA is limiting the dose to ensure that too much is not given, which can result in toxicity, morbidity, and even mortality.

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