From the Guidelines
Weight-based dosing for pain management should be prioritized, with acetaminophen dosed at 10-15 mg/kg every 4-6 hours and ibuprofen at 5-10 mg/kg every 6-8 hours in infants and children, as recommended by the most recent study 1. For infants and children, the following weight-based doses are recommended:
- Acetaminophen: 10-15 mg/kg every 4-6 hours (maximum 75 mg/kg/day) 1
- Ibuprofen: 5-10 mg/kg every 6-8 hours (maximum 3200 mg daily) 1
- Morphine: 0.05-0.1 mg/kg every 4-6 hours 1
- Hydrocodone: 0.1-0.2 mg/kg every 4-6 hours 1 In adolescents and adults, the recommended doses are:
- Acetaminophen: 10-15 mg/kg every 4-6 hours (not exceeding 4000 mg daily) 1
- Ibuprofen: 5-10 mg/kg every 6-8 hours (maximum 3200 mg daily) 1
- Morphine: 0.1-0.2 mg/kg every 4 hours 1
- Hydrocodone: 0.1-0.2 mg/kg every 4-6 hours 1 Elderly patients (over 65) generally require dose reductions of 25-50% due to altered metabolism and increased sensitivity, as suggested by study 1. Medication selection should consider the pain type, severity, and patient-specific factors like kidney and liver function. Always start with the lowest effective dose and titrate as needed, especially with opioids, which should be used for the shortest duration necessary due to risks of dependence and respiratory depression. The use of a multimodal analgesic approach, including acetaminophen, gabapentinoids, NSAIDs, lidocaine patches, and tramadol, is recommended for elderly patients, as stated in study 1. Peripheral nerve blocks and epidural analgesia may also be considered for pain management in elderly patients, as recommended by study 1. It is essential to carefully evaluate the use of neuraxial and plexus blocks in patients receiving anticoagulants to avoid bleeding and complications, as warned by study 1. Non-pharmacological measures, such as immobilizing limbs and applying dressings or ice packs, may be used in conjunction with drug therapy to control acute pain in elderly patients, as suggested by study 1.
From the FDA Drug Label
The recommended dosages for adults and pediatric patients 1 month of age and older are included in Table 1. Administer the total daily dosage orally in two or three divided doses as indicated in Table 1. In pediatric patients, the recommended dosing regimen is dependent upon body weight Based on clinical response and tolerability, dosage may be increased, approximately weekly. Table 1. Recommended Dosage for Adults and Pediatric Patients 1 Month and Older Age and Body Weight Recommended Initial Dosage Recommended Maximum Dosage Frequency of Administration Adults (17 years and older) 150 mg/day 600 mg/day 2 or 3 divided doses Pediatric patients weighing 30 kg or more 2.5 mg/kg/day 10 mg/kg/day (not to exceed 600 mg/day) 2 or 3 divided doses Pediatric patients weighing less than 30 kg 3.5 mg/kg/day 14 mg/kg/day 1 month to less than 4 years of age: 3 divided doses 4 years of age and older: 2 or 3 divided doses
The recommended weight-based doses of pregabalin for pain management are:
- For pediatric patients weighing 30 kg or more:
- Initial dose: 2.5 mg/kg/day
- Maximum dose: 10 mg/kg/day (not to exceed 600 mg/day)
- For pediatric patients weighing less than 30 kg:
- Initial dose: 3.5 mg/kg/day
- Maximum dose: 14 mg/kg/day
- For adults (17 years and older):
- Initial dose: 150 mg/day
- Maximum dose: 600 mg/day 2
From the Research
Pain Management in Patients from 0 to 70 Years
The management of pain in patients from 0 to 70 years involves the use of various medications, including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant analgesics.
- Paracetamol: Recommended as first-line treatment for acute and persistent pain, particularly for musculoskeletal pain, due to its efficacy and good safety profile 3. The maximum daily dose should not exceed 4 g/24 h.
- NSAIDs: Should be used with caution in older people, with the lowest dose provided for the shortest duration 3.
- Opioids: May be considered for patients with moderate or severe pain, but must be individualized and carefully monitored 3, 4.
- Adjuvant analgesics: Used to reduce opioid adverse effects or improve poorly controlled pain, including NSAIDs, tricyclic antidepressants, and antiepileptic drugs 5.
Weight-Based Doses
The weight-based doses of medications for pain management are not explicitly stated in the provided studies. However, it is recommended to start analgesics at low dosages and titrate slowly, especially in older adults 5.
- Pediatric patients: The dosage of medications for pain management in pediatric patients is typically based on weight, but the specific doses are not provided in the studies.
- Adult patients: The dosage of medications for pain management in adult patients is typically based on the type and severity of pain, as well as the patient's medical history and current medications.
Non-Pharmacological Approaches
Non-pharmacological approaches, such as exercise, education, and complementary therapies (e.g., acupuncture, massage), can also be effective in managing pain in patients from 0 to 70 years 3, 6.