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Convenient statements to include in discharge notes for analgesia.
In this section:
1) Standard Analgesic Stepladder – short term. longer term.
2) Severe Pain Management Plans – generic. neuropathic pain.

Part 1: Standard Analgesic Stepladders

1.1 Standard Analgesic Stepladder (Shorter Term)
[REGULARLY] Take 2 x 500mg paracetamol (Panadol) tablets every 5-6 hours (max 8 tabs / day)
[REGULARLY] Take 2 x 200mg ibuprofen (Neurofen) tablets every 6-8 hours with breakfast/dinner. (max 6 tabs / day)
[AS REQUIRED] Take 2 x 500/30mg Paracetamol/Codeine (Panadeine Forte) *INSTEAD* of 2 x 500mg paracetamol every 5-6 hours (max 8 tabs / day) if pain is severe.

NOTE: Paracetamol/Codeine can be taken *INSTEAD* of Paracetamol if pain is severe. Maximum of 8 tablets containing paracetamol 500mg per day.
Do not take any other nonsteroidal anti-inflammatories such as diclofenac (voltaren) or meloxicam (Mobic), mefenamic acid (ponstan), or naproxen
Do not take ibuprofen for more than 3 days in a row. Prolonged use of any NSAID can cause stomach ulcers. See your GP in 3 days if you have an ongoing requirement for painkillers.

1.2 Standard Analgesic Stepladder (Longer Term)
[REGULARLY] Take 2 x 500mg paracetamol (Panadol) tablets every 5-6 hours (max 8 tabs / day)
[REGULARLY] Take 2 x 200mg ibuprofen (Neurofen) tablets every 6-8 hours with breakfast/dinner. (max 6 tabs / day)
[REGULARLY] Take 1 x 40mg pantoprazole (Somac), about 20 minutes before your biggest meal of the day.
[AS REQUIRED] Take 1 x 50mg Tramadol, every 6-8 hours, as required for breakthrough pain.

NOTE: As you have been started on an anti-inflammatory medication, and are expected to continue for over 3 days, take 40mg pantoprazole once a day, 15-20mins before your biggest meal of the day. This is to prevent stomach inflammation. Do not take any other nonsteroidal anti-inflammatories such as diclofenac (voltaren) or meloxicam (Mobic), mefenamic acid (ponstan), or naproxen. Do not take Tramadol unless advised by your doctor if you are on antidepressants or mood stabilizers.

Part 2: Severe Pain Management Plans

2.1 Severe Pain Management Plan
[REGULARLY] Take 2 x 500mg paracetamol (Panadol) tablets every 5-6 hours (max 8 tabs / day)
[REGULARLY] Take 2 x 200mg ibuprofen (Neurofen) tablets every 6-8 hours with breakfast/dinner. (max 6 tabs / day)
[REGULARLY] Take 1 x 100mg Tapentadol Slow Release every 12 hours
[AS REQUIRED] Take 1 x 50mg Tapentadol Immediate Release every 8-12 hours as required for breakthrough pain.

Do not take any other nonsteroidal anti-inflammatories such as diclofenac (voltaren) or meloxicam (Mobic), mefenamic acid (ponstan), or naproxen. As you have been started on an anti-inflammatory medication, and are expected to continue for over 3 days, take 40mg pantoprazole once a day, 15-20mins before your biggest meal of the day. This is to prevent stomach inflammation. See your GP in 5-7 days to review your pain management plan – an intentionally limited number of tablets have been prescribed.

2.2 Severe Pain Management Plan (+neuropathic pain medication)
*eg for Sciatica flareups.
[REGULARLY] Take 2 x 500mg paracetamol (Panadol) tablets every 5-6 hours (max 8 tabs / day)
[REGULARLY] Take 2 x 200mg ibuprofen (Neurofen) tablets every 6-8 hours with breakfast/dinner. (max 6 tabs / day)
[REGULARLY] Take 1 x 40mg pantoprazole (Somac) once a day, about 20 minutes before your biggest meal.
[REGULARLY] Take 1 x 100mg Tapentadol Slow Release every 12 hours
[REGULARLY] Take 2 x 25mg Pregabalin once a day at NIGHT.
[LIMITED FOR THREE DAYS] Take 2 x 25mg Prednisolone (Solone) tablets once in the morning for THREE DAYS ONLY, then stop.
[AS REQUIRED] Take 1 x 50mg Tapentadol Immediate Release every 8-12 hours as required for breakthrough pain.

Do not take any other nonsteroidal anti-inflammatories such as diclofenac (voltaren) or meloxicam (Mobic), mefenamic acid (ponstan), or naproxen. As you have been started on an anti-inflammatory medication, and are expected to continue for over 3 days, take 40mg pantoprazole once a day, 15-20mins before your biggest meal of the day. This is to prevent stomach inflammation. See your GP in 5-7 days to review your pain management plan – an intentionally limited number of tablets have been prescribed. There is some evidence steroids (prednisolone) may benefit your condition (NNT = 6). Your GP may need to make adjustments to the pain management plan above and change the dosage and frequency of medications based on your response.

Part 3: List of Common Orders (tick box list to give JMS)

Waste less time giving analgesia plans to JMS with simple tick box list below:
It is as generic and as broad as can be.

Always ensure:
Administration time is checked on digital ordering system to ensure first dose is not delayed (regular doses often pushed forward to next timeslot)
Doses titrated for patients with comorbidities eg renal failure, liver failure, dialysis, or weight extremities.

1) Everyone gets, unless contraindicated:
[  ] Paracetamol 1g QID regular
[  ] Paracetamol 1g IV QID regular
[  ] Paracetamol 1g PO Dissolvable QID regular
[  ] Paracetamol 1g PR QID regular (fasting status and IV access issues be damned. every patient will get panadol!) 

2) Anti-inflammatory
[  ] Ibuprofen 400mg TDS (less GI bleed risk for long term use)
[  ] Celecoxib 100mg BD (less bleeding risk on NOAC / warfarin)
[  ] IM Ketorolac 10mg TDS (if not tolerating oral medications)
[  ] Indomethacin 100mg PR/PO BD (for renal colic + vomiting / not tolerating orals)
[  ] Parecoxib 40mg IV OD (consider bleeding risk with pending surgery)
[  ] Diclofenac 50mg TDS (renal colic + tolerating orals)

3) Longer term background pain relief
[  ] Tapentadol 50mg Slow Release BD
[  ] Tapentadol 100mg Slow Release BD
[  ] Tramadol 100mg Slow Release BD
[  ] Oxycodone 5mg Slow Release BD
[  ] Oxycodone 10mg Slow Release BD
[  ] Oxycodone/Naloxone 5mg/2.5mg Slow Release BD

4) As Required / PRN Top Up Medications
[  ] Tapentadol 50mg-100mg Immediate release q4h PRN
[  ] Tramadol 50mg IV/PO QID PRN
[  ] Oxycodone 5-10mg Immediate release q4h PRN

5) Severe Pain Loading
[  ] Morphine 7.5mg IV stat
[  ] Fentanyl 75microg IV stat
[  ] Fentanyl 100microg IN stat

6) Severe Pain PRN
[  ] Morphine 2.5mg IV q5min PRN (max dose 20mg total)
[  ] Fentanyl 25microg IV q5min PRN (max dose 200microg total)
[  ] Ketamine 10mg IV q5min, for 4 doses only. (for severe refractory pain. Contact APS for ongoing administration)

7) Nerve Pain Addendums
[  ] Prednisolone 50mg OD (for three days only)
[  ] Pregabalin 75mg BD (initial dose. GP to titrate up to 400mg / day)
[  ] Amitriptyline 25mg nocte (initial dose. GP to titrate up to 75mg / day)
[  ] Gabapentin 100mg nocte (initial dose. GP to titrate up to 900mg/day)
[  ] Diazepam 5mg q1hr PRN (limited doses, 2 doses only for acute ED treatment)
 
8) Additional Common Prescriptions
[  ] Ondansetron 4-8mg IV TDS PRN (note causes decreased GIT motility)
[  ] Metoclopramide 10mg IV TDS PRN (note prokinetic)
[  ] Cyclizine 50mg IV TDS PRN
[  ] Dexamethasone 4mg IV stat
[  ] Droperidol 0.625mg IV q20min PRN, limited 2 doses.