Pain Management with Dr. Sergey Motov, Part 2

OverviewDo 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 PointsSergey'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.