Pain Management Part 2
Pain Management with Dr. Sergey Motov, Part 2
Dec. 1, 2020
Do you ever get overwhelmed with all the ED analgesic options? In part 2 of our series on ED Pain Management, Dr. Sergey Motov of Maimonides Medical Center helps break things down, reviewing a few cases and finishing with Sergey's 10 Commandments of ED Pain Management.
Host
Matt Dillon, MD
ChristianaCare EM/IM, PGY-4
Twitter: @mdmd_8889
EMRA*Cast Episodes
Guests
Sergey Motov, MD
Maimonides Medical Center
@painfreeED
Overview
Do you ever get overwhelmed with all the ED analgesic options? In part 2 on ED Pain Management, Dr. Sergey Motov helps break things down, reviewing a few cases and finishing with Sergey’s 10 Commandments of ED Pain Management.
Key Points
Sergey's 10 Commandments of ED Pain Management
- Titrate opioids regardless of initial dosing regimen: weight-based, fixed, or nurse-initiated.
- Use alternatives (to IV) routes of analgesic administration: PO, PR, IN, SubQ, nebulized, topical.
- Utilize sub-dissociative dose ketamine for selected acute and chronic painful conditions.
- Educate patients about appropriate expectations of pain course and management.
- Embrace a concept of channels/enzymes/receptors targeted analgesia.
- Use NSAIDs based on their analgesic ceiling dose.
- Attempt to use non-opioid analgesics whenever possible.
- Promote nerve blocks for a variety of acute painful conditions (trauma, infection, inflammation).
- DO NOT prescribe long-acting opioids, SR/ER opioids, or fentanyl patches in the ED or at discharge.
- If indicated, DO prescribe a short course of immediate release opioids (preferably morphine sulfate IR) at discharge and arrange proper follow-up.
Resources and References
- Cisewski DH, Motov SM. EMRA Pain Management Guide. EMRA. Dallas, Texas:2020.
- App version available within MobilEM at iTunes and Google Play.
- Motov SM. PainFreeED.com.
