Table 5: Oral Opioids for Acute Pain in Opioid-Naïve Adults
Available Oral Strengths Tablets: • 15 mg • 30 mg Tablets: • 10 mg/0.5 mL • 10 mg/5 mL • 20 mg/5 mL • 20 mg/5 mL • 100 mg/5 mL
Medication
Moderate Pain Severe Pain
Clinical Considerations
Morphine * (Only available as generic)
10 to 30 mg PO every four hours as needed.
Utilized only for severe, acute pain; not a first-line acute pain agent. Start with a low dose and titrate carefully.
Oxycodone * • Oxaydo • Roxicodone • Roxybond
Capsules: • 5 mg Tablets: • 5 mg • 7.5 mg • 10 mg • 15 mg • 20 mg • 30 mg
5 to 15 mg PO every four to six hours.
Utilized only for severe, acute pain; not a first-line acute pain agent. Start with low a dose and titrate carefully.
Oral Solution: • 5 mg/5 mL • 20 mg/5 mL • 100 mg/5 mL
Tramadol (Ultram)
Tablets: • 50 mg
1 to 2 tablets PO every four to six hours as needed.
Maximum dose (<75 years): 400 mg/ day. Maximum dose (75 years and older): 300 mg/day
* Note : Avoid extended-release formulations and long-acting opioids in acute pain.
Healthcare Consideration: 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 (AAFP, 2021). INTEGRATIVE NURSING
Kreitzer and Koithan (2019) define integrative nursing as a “way of being-knowing-doing that advances the health and well- be- ing of persons, families, and communities through caring/healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support whole person/whole sys- tem healing” (p. 4). Integrative medicine and integrative nursing are the same. In the past, these therapies were called comple- mentary because they were adjuncts to the prescribed treatment regimen. Some called these therapies nonsense. The opioid epi- demic has pressured providers with the option to prescribe more controlled substances or offer alternatives. Literature shows that integrative therapies positively affect pa- tients’ perception of pain. DeBar et al. (2022) found that primary care–based cognitive behavioral therapy intervention (CBT), using frontline clinicians, produced modest but sustained reductions in measures of pain and pain-related disability compared with usual care. Yoga and low back pain demonstrated a similar positive finding. A systematic review published in 2022 found that yoga revealed robust short- and long-term effects on pain, disability, physical function, and mental health compared with nonexercise controls (Anheyer et al., 2022). In their book Integrative Nursing , Kreitzer and Koithan (2019) of- fer a tiered approach to pain management. Nurses have offered these therapies to their patients for years. The different tiers and integrative therapy approaches are shown in Table 6.
Table 6: Tiered Integrative Approaches to Pain Management* Tiered Intervention Integrative Approaches Tier 1 Hot/cold therapy Relaxation response Guided imagery Tier 2 Aromatherapy Yoga Hydrotherapy Tier 3 Cognitive-behavioral (pain management therapy
Mindfulness-based stress reduction meditation Massage Acupressure
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