November 12, 2004
Hospitalization for Pain
Prepared October 14, 2004
By Howell Johnson, M.D., Associate Medical Director
Pain from the low back, headaches and other painful conditions can often be managed with oral analgesics on an outpatient basis.
Severe pain may require combination analgesic therapy such as acetaminophen, non steroidal antiinflammatory (NSAIDS) and both sustained and immediate release opioids.
In addition to combination analgesic treatment, useful adjuvant drugs include anticonvulsants (neurontin, carbamazepine), tricyclic antidepressants (amitriptyline, nortriptyline), and corticosteroids (dexamethasone, methylprednisolone.)
Twenty-three hour observation admissions may be medically necessary for severe refractory pain to allow parenteral analgesics while oral analgesics are titrated to reasonably effective doses. At the time of admission, oral analgesics should be started, continued, or increased rather than discontinued. With this approach an earlier effective oral analgesic regimen can be achieved and the time needed for parenteral analgesic and thus hospitalization is shortened.
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