What medication can be given for immediate pain relief?

Immediate Pain Relief Medication Options

For immediate pain relief, acetaminophen (paracetamol) and/or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen should be administered as first-line treatment for mild to moderate pain, with immediate-release opioids reserved for severe pain. 1

Pain Assessment and Medication Selection Algorithm

1. Assess pain severity (using numerical pain scale):

   • Mild pain (1-3/10): Start with non-opioid analgesics
   • Moderate pain (4-6/10): Consider stronger non-opioids or weak opioids
   • Severe pain (7-10/10): Use strong opioids with/without non-opioids

2. First-line options for immediate relief:

   • Mild pain (1-3/10):

     • Acetaminophen 1000 mg orally 1, 2
     • Ibuprofen 400 mg orally 3, 4
     • Consider combination of acetaminophen + NSAID for enhanced effect

   • Moderate pain (4-6/10):

     • Combination therapy: Acetaminophen 1000 mg + ibuprofen 400 mg 1, 4
     • Alternative: Weak opioids (codeine, tramadol) combined with non-opioid analgesics 1

   • Severe pain (7-10/10):

     • Immediate-release oral morphine 1
     • Intravenous opioids for faster onset 1
     • Buccal, sublingual, or intranasal fentanyl for breakthrough pain 1

Key Considerations for Specific Medications

Acetaminophen (Paracetamol)

• Dosing: 1000 mg provides effective analgesia for about 4 hours 2
• Advantages: Safe profile, minimal side effects, suitable for patients with GI, renal, or cardiovascular issues 5
• Maximum daily dose: 4000 mg (generally 3000 mg recommended for patients with liver disease) 1
• Caution: Reduced dosing in patients with liver cirrhosis 1

NSAIDs (Ibuprofen)

• Dosing: 400 mg every 4-6 hours 3, 4
• Advantages: Effective for inflammatory pain
• Maximum daily dose: 3200 mg 3
• Caution: GI toxicity, renal impairment, cardiovascular risks with prolonged use

Opioids for Severe Pain

• Immediate-release morphine: First choice for moderate to severe pain 1
• Dosing strategy: Individual titration using immediate-release formulations administered every 4 hours plus rescue doses (up to hourly) for breakthrough pain 1
• Alternative routes: Intravenous, buccal, sublingual, or intranasal formulations provide faster onset for urgent pain relief 1

Important Clinical Pearls

• Timing matters: Administer analgesics "by the clock" rather than "as needed" for better pain control 6
• Anticipatory dosing: For predictable pain episodes (e.g., before eating or movement), administer medication 20 minutes before the trigger 1, 6
• Combination therapy: Using acetaminophen with NSAIDs can provide superior analgesia than either agent alone 4
• Breakthrough pain: Always prescribe immediate-release formulations for breakthrough pain in addition to regular baseline therapy 1

Common Pitfalls to Avoid

1. Underdosing: Inadequate dosing leads to poor pain control and unnecessary suffering
2. Delayed administration: Waiting until pain is severe makes it harder to control
3. Ignoring breakthrough pain: Failure to provide rescue medication for pain spikes
4. Inappropriate opioid use: Using strong opioids for mild pain or avoiding them when needed for severe pain
5. Not addressing side effects: Failing to prevent opioid-induced constipation with prophylactic laxatives 1

For immediate pain relief, the most effective approach is prompt administration of appropriate analgesics based on pain severity, with regular reassessment and dose adjustment to optimize pain control while minimizing adverse effects.