CERTA Opioid Alternatives as Analgesics

 Dr. Sergey Motov (USA Emergency Medicine) & Dr. David Lyness (UK/IRE Anaesthetics)
Originally put on this website in July 2016
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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 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.
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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. 

1. Consider the use of PPI's when using NSAID drugs.
2. Caution with using NSAIDs where surgery could be imminent.

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 document is for review in 2018 - so please contact us if you have anything to add!

FULLSCREEN 
​References in document below...