The PAMI Pain Management and Dosing Guide helps health care providers safely relieve a patient’s pain in acute care settings.
It stops you in your tracks and suddenly nothing else matters. The discomfort can be unbearable or create just enough distress to distract you from your daily routine. It can throb, stab, pinch, cramp, gnaw, burn, shoot or radiate from anywhere in your body. And it is among the top reasons patients seek health care.
“Pain has been an issue for a long time. Studies show that up to 78 percent of all ER visits are related to pain,” said Sophia Sheikh, MD, an assistant professor of emergency medicine at the University of Florida College of Medicine – Jacksonville. “So it is vital that we have resources for providers that they can reference easily to help them manage pain.”
For every way you can feel pain, there are potential remedies to reduce it, and the method used often plays a big role in how long pain lasts. Faculty physicians involved in the Pain Assessment and Management Initiative, or PAMI, at the UF COMJ created a free PAMI Pain Management and Dosing Guide to help health care providers effectively relieve pain in acute care settings.
“We have both a dedicated pediatric emergency department and an emergency room for adult patients, on top of our Level I trauma center,” Sheikh said. “We get the whole spectrum of traumatic injuries to general medical conditions that can cause pain, and we took that into account in this guide.”
Dosing Guide Breakdown
The dosing guide easily folds into a trifold brochure, providing six panels of important information to consider when deciding on the best treatment for pain.
The first panel highlights the patient and environmental safety factors that should be considered.
The second panel features the most commonly used classes of medications for pain such as opioids and nonsteroidal anti-inflammatory drugs, or NSAIDs, with both adult and pediatric dosing. There is even a table providing dosing for medications that can be inhaled.
The third panel provides dosing for medications commonly used for sedation when a painful procedure is needed, such as reducing a fracture or dislocated bone. It also reviews important principles of pain management and discharge planning for emergency medicine providers.
“Is the patient talking? Are they able to properly walk and move? Are their vital signs okay?” Sheikh said. “How are they going to get home? Do they have a safe way of being transported home? When they are home, who is there to observe or watch over them?”
The fourth panel provides information on medications used to perform nerve blocks, treat neuropathic pain, such as pain from diabetes, muscle relaxers and ketamine, which has recently become popular as a treatment for pain in the emergency department.
The fifth panel has a table with commonly used topical and transdermal medications.
The last panel has information and resources on non-pharmacologic methods for treating pain.
“There is a time and place for opioids,” Sheikh said. “There is no way you can have a functioning emergency department without opioids. That being said, there are times when opioids are not the answer. There are other options. There are alternatives, and that is why the dosing guide can be helpful.”
Faculty involved with PAMI continue to work with other physicians, pharmacists and nurses to get feedback about this guide and discuss ways it can be improved. The guide is also regularly updated to include new Food and Drug Administration regulations and research. PAMI physicians are also exploring the development of a mobile app for easier accessibility.
The free PAMI Pain Management and Dosing Guide can be downloaded by clicking here.
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