A review of current guidelines or online references provides updated recommendations for managing acute pain following dental or surgical procedures or common emergency medical conditions. See, for example, recommendations developed by the University of Michigan (2022) at https:// opioidprescribing.info/ Assessment of acute or chronic pain should be multidimensional. Consideration should be given to
several domains, including the physiological features of pain and its contributing factors, with physicians and other clinicians assessing patients for function, quality of life, mental health, and emotional health. In addition to a complete medical and medication history typically obtained at an office visit, document pain intensity, location, duration, and factors that aggravate or alleviate pain. 99
Table 10: Oral Opioids for Acute Pain in Opioid-Naïve Adults Medication Available Oral Strengths Moderate Pain
Severe Pain Clinical Considerations
Codeine- acetaminophen • Tylenol with codeine
Tablets : 15 mg/300 mg 30 mg/300 mg 60 mg/300
1 to 2 tablets every 4 hours as needed for pain
Increasing doses do not improve efficacy and result in more adverse effects. Limit codeine to no more than 60 mg/dose. Do not exceed codeine 360 mg/24 hours. The maximum dose of acetaminophen is 4,000 mg/ day (from all sources). Metabolism of codeine to morphine (its active form) varies between patients; drug interactions may affect response. Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
Hydrocodone- acetaminophen
Tablets : 2.5 mg/325 mg 5 mg/300 mg 5 mg/325 mg 7.5 mg/300 mg 7.5 mg/325 mg 10 mg/300 mg 10 mg/325 mg Oral solution:
1 to 2 tablets PO every 6 hours as needed
1 to 2 tablets PO every 4 to 6 hours as needed
• Lorcet • Lortab • Norco • Vicodin
7.5 mg/325 mg per 15 mL 10 mg/300 mg per 15 mL 10 mg/325 mg per 15 mL
Oxycodone- acetaminophen*
Tablets: 2.5 mg/325 mg 5 mg/325 mg
1 to 2 tablets PO every 6 hours as needed
1 to 2 tablets PO every 4 to 6 hours as needed
Dosage limited by acetaminophen maximum dose (4,000 mg/day [from all sources]).
• Endocet • Percocet • Primlev • Roxicet • Xolox
7.5 mg/325 mg 10 mg/325 mg Oral solution: 5 mg/325 mg per 5 mL
Tablets: 37.5 mg/325 mg
1 to 2 tablets PO every 6 hours needed
1 to 2 tablets PO every 4 hours as needed
Only FDA-approved for 5 days or less of treatment of acute
Tramadol- acetaminophen • Ultracet Ibuprofen- hydrocodone • lbudone • Reprexain • Vicoprofen • Xylon
pain. Maximum dose: Eight tablets/24 hours.
Tablets: 5 mg/200 mg 7.5 mg/200 mg 10 mg/ 200 mg
1 tablet PO every 4 to 6 hours as needed
FDA-approved for short-term, acute, severe pain (<10 days). Do not exceed 5 tablets/day.
Book Code: MDCO1025
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