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APPENDIX VI: PAIN MANAGEMENT 881

tives [Q oral, tmravenous, or intramuscular drug delivery for pain are

descnbed in Tables VI-4-VI-6. Communication among therapists,

nurses, physicians, and patients on the effectiveness of pain managemenr is essential [Q maximize the patient's comfort. This includes a thorough review of the patient's medical history and the doctor's

orders by the physical therapist before prescribing any modalities or

therapeutic exercises.

Table VI-3. Systemic Op.oids

Indicanon:

Moderate to severe postoperarive pain, can also be used preoperatively

Mechanism of action:

Blocks tran�mission of pain from the spinal cord to the cerebrum by

imeractmg with opioid receptors

Can he adminlsrered orally, IIlrravenously, IIlrramuscularly, subcutaneously,

and imrathecally

General side effecrs:

Decreased gastrointestinal morility, nausea, vomiting, and cramps

Mood changes and sedarion

Prurirus (itchmg)

Unnary retention

Respirarory and cough depression

Pupillary consmetlon

Medications: Generic name (trade name)

Allentanol hydrochloride (Allenta, Rapilen)

Buprenorphllle (Buprenex, Temgesic)

Butorphanol (Stadol)

Codeine (Paveral)

Dezocine (Dalg.n)

Fentanyl (Sublam,"e)

Fentanyl transdermal (Duragesic)

Ilydromorphone (D.I.udid, CD Palladone)

Levorphanol (Dromoran, Levorphan)

Meperidlllc (Demerol, CD Pamergan, CD Pethidine)

Methadone (Dolophinc, Merhadose, Physcprone)

Morphine (MS Contin, Roxanol, Anamorph, Astramorph, Morcap,

Duramorph, Epimorph, Infumorph, Oramorph, Rescudose, Starex)

N.lbuphone (Nubaon)

Naloxone (Narcan)

Oxycodonc (Roxicodone, Supeudol, Endodan, Tylox, Percocet, Percodan)

Oxymorphone (Nulllorphan)

Pentazocine (Fortral, Talwin)

882 ACUTE CARE HANDBOOK FOR PHYSICAL ll-lERAPISTS

Table Vl-3. Continued

Propoxyphene (Darvon, Dolene, Doloxene, Novo-Propoxyn)

Remifentanil (Ultiva)

Sufentanil citrate (Sufenta)

Tramadol hydrochloride (Ultram, Zamadol, Zydol)

Sources: Data from JC Ballantyne, D Borsook. Postoperative Pain. In D Borsook, AA

LeBel, B McPeek (eds), The Massachusetts General Hospital Handbook of Pain Man·

agemcnt. BoSton: Little, Brown, 1996;249; and HL Fields (ed). Pain. New York:

McGmw·Hill, 1987;253; Nursing 2001 Drug Handbook (21st cd). Springhouse, PA:

Springhouse Corporation, 200 t ;368-392; and L Skidmore-Roth (cd). Mosby's Nursing

Drug Reference. 51. Louis: Mosby, 2001;58-59.

Table VI-4. Epidural Catheters

Indications:

Surgeries of the thorax or upper and lower abdomen, especiall)' in patients

with significant pulmonary disease

Surgery of the lower extremity, especially when early mobilization is important

Vascular procedures of the lower extremi[)', when sympathetic blocks are used

Mechanism of action:

Prevent transmission of pain signals to the cerebrum at the spinal level with :1

catheter that is placed in the epidural space.

A mixture of opioids and local anesthetics is often used. This drug combination provides a synergistic effect for pain relief with a decreased incidence of side effects.

If patients do experience adverse side effects, nonsteroidal anti-inflammatory

drugs can be added to the mixture, and the dosages of the opioids or local

anesthetics are reduced.

General side effects:

Epidural opioids

Pruritus (itching), nausea, sedation and respiratory depression, decreased

gastrointestinal motility

Local anesthetics

Hypotension, temporary lower-extremity weakness, urine retention,

local anesthetic toxicity (ringing in the ears, metallic taste, slow

speech, irritability, cardiac arrhythmias, and seizures)

Medications: Generic (trade name)

Epidural opioids

Morphine, fentanyl, sufentanil, alfentanil, hydromorphone (Dilaudid),

and meperidine (Demcrol)