Page 363 Guide to Pain Management in Low-Resource Settings

Chapter 49

Profi les, Doses, and Side Eff ects of Drugs Used in Pain Management

Barbara Schlisio

Th e following drug list is a selection of commonly used of high methodological quality. Th is means that safety
drugs for pain management. Th e selection refl ects rec- is an issue to be considered when selecting a drug: the
ommendations of the “Essential Drug List for Cancer” possible positive eff ects must always be balanced against
from Makarere University and the health ministry in possible side eff ects. A good recommendation would be
Uganda for the treatment of cancer patients, which ap- to think, when prescribing a drug, whether you would
pear to be a reasonable drug selection for treatment prefer the same drug when in a comparable situation,
of the most common pain syndromes encountered by since it is your decision to select pharmacological treat-
nonspecialists in a low-resource setting. ment.
Th is overview explains the mode of action as Pharmacological treatment should be explained
well as typical side eff ects of drugs. “Typical side eff ects” thoroughly to the patient, and “informed consent”
means that other side eff ects have been described, but I should be obtained in the same way as for a surgical in-
have selected from the lengthy lists of side eff ects men- tervention. A valuable tool to avoid misunderstandings
tioned in desk references the ones that are most impor- and “incompliance” by the patient is the use of a simple
tant for the therapist and the patient to know about. (makeshift) “information sheet” to be given to patients
Pharmacological therapy in pain management is when they leave the offi ce with their prescription.
often selected because of positive empirical knowledge, Here is an example of an information sheet to
because most of the time there are no controlled studies give to patients:

Name of Drug How to Take It What Is It For ? Important Information
Morphine 1 tablet of 20 mg: Strong painkiller for con- Nausea and tiredness are possible
6–12–18–24 o’clock tinuous pain control the fi rst week. Never change the
dose on your own!
Morphine 1 tablet of 10 mg as needed Strong painkiller to be taken See above. Minimum time between
if pain increases extra morphine tablets: 30 minutes.
Metoclopramide 40 droplets: Prevents nausea caused by Should be taken for 10 days. After
6–12–18–24 o’clock morphine that, try to go without it.
Carbamazepine 1 tablet of 200 mg: Helps against shooting Dizziness and tiredness in the fi rst
8–16–24 o’clock nerve pain few days or weeks. Remember to
come to the offi ce to have a blood
sample taken in one week.

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 351
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.