PDF included at bottom of page for a clearer graphic (incl. 811 references!)
Fullscreen of the graphic below: here.
Dr. Sergey Motov (USA Emergency Medicine) & Dr. David Lyness (UK ICM/Anaesthetics)
UPDATE - NOVEMBER 2018
Taken from Dr Motov's work on a CERTA regime.
This is published in conjunction with the CERTA concept explanation here.
We can all provide superior analgesia by using medication and techniques other than just opioid medications.
This is NOT a definitive list and in all cases, local policies and protocols should be followed. Check your local formularies.
This is NOT a prescribing guideline - it is for EDUCATIONAL information ONLY.
We do not dispute the role of opioids in many spheres of practice, including emergency medicine, ICU and anaesthetics; rather we wish to highlight the pandemic of high opioid and opiate use. There are many medications available to reduce the amount of opioids used.
You may find, when considering your analgesia regimes that opioids are not always the best options for emergency pain issues.
We would advocate the use of nerve blocks in the first instance to control acute pain, when feasible.
With respect to alternatives listed for non-radicular back pain, it has been brought to our attention that a new study was presented in 2017 which showed that "diazepam has no benefit when added to naproxen vs placebo" in acute low back pain. See here.
This is a difficult document to see online - so I have included a fullscreen version here and the A3 printable PDF below.
There were 811 references when compiling this document; they can be found below....
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