This document outlines the 4 steps for pain management: 1) non-opioids like ibuprofen and paracetamol, 2) weak opioids like codeine and tramadol, 3) non-pharmacological options like acupuncture, yoga, and nerve blocks, and 4) strong opioids like morphine and oxycodone as a last resort. Each step provides examples of options, associated side effects to consider, and important notes. The overall approach emphasizes non-opioid and non-pharmacological strategies first due to current opioid crises before considering stronger opioids.

1. PAIN
MANAGEMENT
Dr Manzoor Hussain Narejo
MBBS

2. Pain Management
THERE ARE 4 STEPS FOR PAIN MANAGEMENT
 NON-OPIOIDS
 WEAK OPIOIDS
 NON-PHARMACOLOGICAL
 STRONG OPIOIDS

3. NON-OPIOIDS
 This is 1ST STEP OF pain management
 It includes
NSAIDS i.e IBUPROFEN, NAPROXEN, PARACETAMOL
 SIDE EFFECTS: Gastric ulcers, increase risk of bledding, decrease renal
blood flow
 CONTRAINDICATION: Chronic kidney disease, heart failure, chirrhosis,
asthma ( severe)
 NOTE: Paracetamol is contraindicated in liver diseases

4. WEAK OPOIDS
 It is the 2nd line of pain management
 It includes:
Codeine, Tramadol, Co-Codamol
 Side effects: Codeine(constipation), Tramadol( Agitation)
 Note: Avoid overdose

5. NON PHARMACOLOGIC
 It is 3rd step of pain management
 It includes
a) Acupuncture
b) Yoga
c) Massage
d) Nerve block
e) Radiofrequency
f) Disc Decompression
 Note: This step is emphasize due to current opioids crises

6. STRONG OPIOIDS
 This is the 4th step of pain management
 It includes:
Morphine Sulphate, IV Morphine, Oxycodone
 Side effects: Constipation, Nausea, Sedation, Respiration depression,
Addiction
 Note: Antidote is Naloxone