Core IM | Internal Medicine Podcast #36 Pain Management: 5 Pearls Segment
Mar 13, 2019
Dr. Shani Herzig, a hospitalist and researcher focused on safe opioid use, weighs in on inpatient pain management. Short, practical takes cover when nonopioids rival opioids, smart NSAID use in kidney/heart/liver disease, opioid-sparing combos with acetaminophen, and safe opioid prescribing and discharge practices.
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Schedule Non‑Opioids First
- Use scheduled non-opioids as the foundation for inpatient musculoskeletal pain control rather than PRNs.
- Example regimens: ketorolac 15 mg q6h plus acetaminophen 1 g q8h or naproxen 500 mg q12h with scheduled Tylenol.
Postpartum Stay Example Shows PRN Gaps
- The hosts recalled difficulty obtaining PRN meds during overnight postpartum stays to illustrate nursing workload and benefit of scheduled meds.
- Alexis noted teams often place PRNs without informing patients, so scheduled orders improve access.
NSAIDs Often Work As Well As Opioids
- NSAIDs have at least equal efficacy to opioids for many acute pain syndromes and carry fewer side effects.
- Cochrane reviews (post-op, low back pain, nephrolithiasis) consistently show NSAIDs ≥ opioids for analgesia.