What are the inpatient pain medications?

From the Guidelines

For inpatient pain management, I recommend a multimodal approach starting with scheduled acetaminophen and NSAIDs, and adding opioids such as morphine or hydromorphone as needed, with careful consideration of the patient's renal function and potential for opioid-related adverse effects. When selecting opioids, it is essential to consider the patient's pain intensity, current analgesic therapy, and concomitant medical illness, as stated in the 2019 NCCN clinical practice guidelines in oncology 1. The choice of opioid should be individualized, with pure agonists such as morphine, oxycodone, and hydromorphone being commonly used for cancer pain management 1. Some key points to consider when managing inpatient pain include:

• Using a multimodal approach to target different pain pathways and reduce opioid requirements
• Selecting opioids with caution in patients with fluctuating renal function due to potential accumulation of renally cleared metabolites that may cause neurologic toxicity 1
• Monitoring for opioid-related adverse effects, including respiratory depression, constipation, nausea, and sedation, and providing appropriate prophylaxis
• Regularly assessing pain using a 0-10 scale to guide medication adjustments
• Gradually transitioning from IV to oral medications and reducing opioid doses as the patient improves, while maintaining non-opioid analgesics. It is also important to note that low-dose morphine has been shown to have a higher response rate and earlier onset of response compared to "weak opioids" such as codeine or tramadol for treating moderate-intensity cancer pain, as demonstrated in a randomized trial 1.

From the FDA Drug Label

The administration of morphine sulfate injection may obscure the diagnosis or clinical course in patients with acute abdominal condition.

5.11 Use in Biliary Surgery or Disorders of the Biliary Tract Morphine sulfate injection may cause spasm of the sphincter of Oddi and diminish biliary and pancreatic secretions.

Fentanyl transdermal system is indicated for management of persistent, moderate to severe chronic pain that: requires continuous, around-the-clock opioid administration for an extended period of time, and cannot be managed by other means such as non-steroidal analgesics, opioid combination products, or immediate-release opioids

The inpatient pain medications are:

• Morphine (IV): used for acute pain management, but may obscure diagnosis in patients with acute abdominal conditions and cause spasm of the sphincter of Oddi.
• Fentanyl (IV): not explicitly mentioned as an inpatient pain medication in the provided text, but Fentanyl transdermal system is indicated for management of persistent, moderate to severe chronic pain. However, the text does not provide information on the use of Fentanyl (IV) for inpatient pain management. 2 3

From the Research

Inpatient Pain Medications

The following are some of the inpatient pain medications:

• Acetaminophen: used for mild to moderate pain 4, 5, 6
• Nonsteroidal anti-inflammatory drugs (NSAIDs): used for mild to moderate pain, including topical NSAIDs for non-low back, musculoskeletal injuries 4, 5, 6
• Opioids: used for severe acute pain, including medications that target separate pathways simultaneously, such as acetaminophen/opioid combinations 4, 5
• Adjunctive medications: used to target the underlying condition, such as muscle relaxants for acute low back pain 4, 5
• Medications with dual actions: such as tapentadol, which can be used for severe or refractory acute pain 4, 5
• Non-opioid alternatives: such as gabapetoids, intravenous agents, local anesthetic infiltration, and peripheral nerve blocks, which can be used alone or in combination for pain management 7, 8

Specific Medications

Some specific medications used for inpatient pain management include:

• Acetaminophen/opioid combinations: such as acetaminophen/hydrocodone or acetaminophen/oxycodone 4, 5
• NSAID/opioid combinations: such as ibuprofen/oxycodone or naproxen/hydrocodone 5
• Tapentadol: a medication with dual actions that can be used for severe or refractory acute pain 4, 5
• Tramadol: a medication that works on opioid and monoamine receptors, which can be used for severe or refractory acute pain 5
• Celecoxib: a cyclooxygenase-2 selective NSAID that can be used with caution in patients with cardiovascular risk factors 4