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A Better Opioid
Gastric erosion, peptic ulcer,
inflammation of the duodenum and
of the colon, renal toxicity with
prolonged use
34
Relistor
(Progenics/Wyeth);
Constipation, sedation,
confusion, respiratory
Tapentadol (J&J), DOR
depression, mental clouding,
agonists renal colic, (Adolor/Pfizer);
tolerance to
abuse-deterrent prolonged use and risk opioids of
(King/Alpharma/Acura,
abuse, misuse, addiction.
Pain Therapeutics,
Acurox)
Gastrointestinal ulcers,
stomach bleeding,
tinnitus
Step 1: Mild Pain (1-3/10)
• Aspirin (ASA)
• Acetaminophen (APAP)
• Nonsteroidal
anti-inflammatory drugs (NSAIDs)
• +/- Adjuvants
© Defined Health, 2009
Pain Insight Briefing
Step 2: Moderate Pain (4-6/10)
• APAP or ASA +
– Codeine
– Hydrocodone
– Oxycodone
– Dihydrocodeine
– Tramadol (not available
with APAP or ASA)
– +/- Adjuvants
Step 3: Severe Pain (7-10/10)
• Morphine
• Hydromorphone
• Methadone
• Levorphanol
• Fentanyl
• Oxycodone
• +- Nonopiod analgesics
• +/-Adjuvants
•Adjuvant Therapy:
– Anticonvulsants
– Antidepressants
– Corticosteroids
– Dermal analgesics
– Muscle relaxants
– Stimulants