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Original Date: 05/2013
Supercedes: 06/2014
Last Review Date: 09/2017
Purpose: To employ an evidence-based approach to multimodal pain management that improves overall outcomes, patient satisfaction, pain management, and patient functional status while minimizing opioid-related adverse events and decreasing length of stay.

Consider patient’s age, allergies, weight, renal/hepatic function, surgical procedures, injuries and prior opioid use when choosing an opioid dose. Dosage adjustments should be determined by patient’s response. Unless specifically contraindicated, the ASA Acute Pain Task Force Guidelines recommend the use of a multimodal pain management therapy plan, neuraxial/regional blockade with local anesthetics, and an around-the-clock regimen of COXIBs, NSAIDs, or acetaminophen.4

  • Multimodal therapy should be initiated in the ED and continued through hospital course.
  • When ordering multimodal pain therapy, please use the Trauma Acute Pain Management Multiphase MPP (in Orders>Surgery>Trauma Surgery).

Pain control for the FIRST 48 hours should include, unless specific contraindication exists (discussed further below):

  • Acetaminophen 1000 mg IV/PO every 6 hours.
    • IV formulation should be used in patients in bowel discontinuity or who are not tolerating PO intake
  • Celecoxib 200 mg PO every 12 hours (contraindicated in patients with eGFR <30 mL/min)
  • Pregabalin 100 mg PO every 8 hours (50mg PO every 8 hours for eGFR <30mL/min)
  • Tramadol 100 mg PO every 6 hours (50 mg PO every 6 hours for eGFR <30 mL/min)