Management of Acute Pain After An Emergency Department Visit:
Acetaminophen (Tylenol) 1,0000 mg every 6 hours as needed
Acetaminophen (Tylenol) 1,0000 mg every 6 hours AND Ibuprofen (Advil) 600 mg every 6 hours as needed for breakthrough pain
Acetaminophen (Tylenol) 1,000 mg every 6 hours AND Ibuprofen (Advil) 600 mg every 6 hours AND Narcotics as needed for breakthrough pain
o ie. Morphine 1-2 tablets every 4 hours as needed
Follow Up: make an appointment to see your Family Doctor within 3-5 days to determine your need
Side Effects (see product monograph for a complete listing, talk to your pharmacist or Family Doctor to ensure these
medications are safe to take with any other medications you take):
Acetaminophen has very few side effects and is one of the safest pain medication, by
continuing to use it on Steps 2 & 3 of the ladder you will significantly decrease your need for the other medications which have much more significant side effects. Avoid other medications
such as cold preparations or Tylenol #3 that also contain acetaminophen, because you risk exceeding the maximum total allowable dose of acetaminophen (4,0000 mg per day).
Ibuprofen is fairly safe when used for short periods of time (less than 5 days), it does
increase your risk of ulcers / gastrointestinal bleeding, should not be used by patients with
impaired kidney function and tends to cause stomach upset. Avoid other similar pain medications (Aspirin, Naproxen, Indomethacin, Ketorolac [Torradol], Diclofenac.consult your pharmacist). If you require Ibuprofen for longer than 5 days speak with your family doctor about the risks / benefits of continuing with Ibuprofen and if you should be on an additional
medication to decrease your risk of stomach ulcer.
Narcotics have many troublesome side effects and ideally should be used for as short a time
as possible. Major side effects include:
o Drowsiness: you cannot operate a motor vehicle, exposed yourself to risk (ie. climbing a
ladder) or make important decisions while taking narcotics.
o Constipation: narcotics will slow down your bowels and prevent normal emptying unless
you increase your fluid and fiber intake, you may also need to take a laxative such as Senokot (Talk to your pharmacist or Google: "BCCA Suggestions for Dealing With Constipation")
o Dependence & Addiction: the risk of addiction and dependence is very low if narcotics
are used properly over a short period of time to treat acutely painful conditions.
o Overdose: if you were to take an overdose of your narcotic medications you may stop
If you find that your pain is becoming intolerable by 6 hours you can try staggering your
medication, that way you will get some additional pain relief every 3 hours. For example:
o Noon: Acetaminophen 1,000 mg o 3pm: Ibuprofen 600 mg o 6pm: Acetaminophen 1,000mg o 9pm: Ibuprofen 600 mg
If narcotics are required to control your pain, it may be helpful to use them more at night and
less during the day. This may help keep you on a normal sleep cycle and minimise your
Relief of chronic pain in cats and dogs: multimodal drug therapy BSc BVSc PhD MRCVS CertVA DSAS(ST) DECVS DACVS North Carolina State University, College of Veterinary Medicine, Key Points: • We must acknowledge that animals experience pain and that chronic pain is associated with significant disadvantages (disturbance of physiology, potentiation of other diseases such as cancer, w
Interactive CardioVascular and Thoracic Surgery 15 (2012) 733–740What is the optimal anticoagulation in patients with a leftMichele Rossi*, Giuseppe Filiberto Serraino, Federica Jiritano and Attilio RenzulliDepartment of Cardiac Surgery, Magna Graecia University, Catanzaro, Italy* Corresponding author. Department of Cardiac surgery, Magna Graecia University, Viale Europa. Germaneto, 88100 Ca