What is a pain medication, other than acetaminophen (Tylenol) or aspirin, for a hospitalized patient?

From the Guidelines

For a hospitalized patient who cannot take Tylenol (acetaminophen) or aspirin, I recommend using opioids as the primary medication to manage pain, as they are equally effective when titrated to similar pain intensity end points, according to the Society of Critical Care Medicine guidelines 1.

Key Considerations

• Opioids remain the primary medications to manage pain in ICU patients, with intravenously administered opioids being the drug class of choice to treat non-neuropathic pain in critically ill patients 1.
• The optimal choice of opioid and the dosing regimen used for an individual patient depend on many factors, including age, underlying comorbidities/end-organ function, and the chosen opioid’s pharmacokinetic and pharmacodynamic properties 1.
• Non-opioid analgesics, such as intravenously administered ketamine, can be used in conjunction with opioids to decrease the overall quantity of opioids administered and the incidence and severity of opioid-related side effects 1.

Recommended Opioid Options

• Morphine (2-4mg IV every 3-4 hours) 1
• Hydromorphone (0.5-1mg IV every 3-4 hours) 1
• Oxycodone (5-10mg orally every 4-6 hours) 1

Important Safety Considerations

• Opioids can cause respiratory depression, constipation, and dependence with prolonged use 1.
• A bowel regimen with a stimulant or osmotic laxative must be prescribed when sustained opioid dosing is initiated to prevent constipation 1.
• Tracking bowel function is a basic component of ICU monitoring 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain NSAID medicines that need a prescription Generic Name Trade Name Naproxen Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac®

Naproxen is a pain medication that is not Tylenol or aspirin containing, and can be used for hospitalized patients.

• Key points:
  • Naproxen is an NSAID medicine used to treat pain and inflammation.
  • It is available by prescription only.
  • It can be used for short-term pain, but the lowest dose possible should be used for the shortest time needed. 2

From the Research

Alternatives to Tylenol or Aspirin for Hospitalized Patients

For hospitalized patients, several alternatives to Tylenol or aspirin can be considered for pain management. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, which are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease.
• Topical NSAIDs, which are recommended for non-low back, musculoskeletal injuries 3.
• Adjunctive medications, such as muscle relaxants, which may be useful for acute low back pain 3.
• Medications that work on opioid and monoamine receptors, such as tramadol or tapentadol, which can be used for severe or refractory acute pain 3.
• Non-opioid analgesic treatment strategies, including multimodal regimens, which can be effective for acute pain management in the Emergency Department (ED) 4.

Non-Pharmacologic Strategies

In addition to pharmacologic options, non-pharmacologic strategies can also be effective for pain management. These include:

• Acupuncture therapy 5.
• Massage therapy 5.
• Osteopathic and chiropractic manipulation 5.
• Meditative movement therapies, such as Tai chi and yoga 5.
• Mind-body behavioral interventions 5.
• Dietary components and self-care/self-efficacy strategies 5.

Hospitalized Patient Considerations

When managing pain in hospitalized patients, it is essential to:

• Evaluate pain effectively 6, 7.
• Develop a rational plan to relieve pain 6.
• Anticipate and manage side effects aggressively 6.
• Trust patients when they report pain 6.
• Plan for the time course of prescriptions and consider the patient's treatment expectations 3.