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Herpes zoster‐associated pain
1. Antiviral agents started within 72 hours of onset of the herpes zoster rash accelerate the
resolution of acute pain (U) (Level I), but do not reduce the incidence of postherpetic
neuralgia (R) (Level I) [Cochrane Review]).
2. Immunisation of persons aged 60 years or older with varicella‐zoster virus vaccine
reduces the incidence of herpes zoster and postherpetic neuralgia (N) (Level II).
3. Amitriptyline (used in low doses for 90 days from onset of the herpes zoster rash)
reduces the incidence of postherpetic neuralgia (U) (Level II).
4. Topical aspirin, topical lignocaine patch or oxycodone controlled release, provide
analgesia in herpes zoster (N) (Level II).
Provision of early and appropriate analgesia is an important component of the SUMMARY
management of herpes zoster and may have benefits in reducing the incidence of
postherpetic neuralgia.
Acute cardiac pain
1. Morphine is an effective and appropriate analgesic for acute cardiac pain (U) (Level II).
2. Nitroglycerine is an effective and appropriate agent in the treatment of acute ischaemic
chest pain (U) (Level IV).
The mainstay of analgesia in acute coronary syndrome is the restoration of adequate
myocardial oxygenation, including the use of supplemental oxygen, nitroglycerine, beta
blockers and strategies to improve coronary vascular perfusion (U).
Acute pain associated with haematological disorders
1. Parenteral corticosteroids appear to reduce the duration of analgesia requirements and
length of hospital stay, without major side effects, during sickle cell crises (S) (Level I
[Cochrane Review]).
2. There is insufficient evidence to suggest that fluid replacement therapy reduces pain
associated with sickle cell crises (N) (Level I [Cochrane Review]).
3. Hydroxyurea is effective in decreasing the frequency of acute crises, life‐threatening
complications and transfusion requirements in sickle cell disease (U) (Level I).
4. Intravenous opioid loading optimises analgesia in the early stages of an acute sickle cell
crisis. Effective analgesia may be continued with intravenous opioid therapy, optimally as
PCA (U) (Level II).
5. Oxygen supplementation does not decrease pain during a sickle cell crisis (U) (Level II).
Pethidine should be avoided for the treatment of acute pain in sickle cell disease or acute
porphyria, with increased seizure risk being a potential problem (U).
Acute pain management: scientific evidence xxxvii
