Stepping up and down the pain ladder
STEPPING UP AND DOWN THE PAIN LADDER
The pain ladder runs stepwise in two directions, click on the arrows to see how you can ensure your customers are recommended the lowest effective dose of pain relief for the shortest length of time.
Initial presentation
- A customer presents with moderate acute pain
- The maximum dose of paracetamol used has had no effect
- They cannot tolerate NSAIDs
- They are on no other medication that may adversely interact with pain medication
Recommendation
- 1. Go to Step 5 and offer a paracetamol-codeine combination
- 2. Advise the patient to return to the pharmacy in 3 days if they are still in pain
- 3. If they return, review next steps on the pain ladder or refer to the GP if appropriate
Subsequent presentation
- After 3 days your customer returns
- They have followed the instructions on the pack
- They are still in pain but report the severity has decreased but not fully resolved
Recommendation
- 1. You recommend they step back down to the maximum dose of paracetamol
- 2. And advise that if this does not continue to manage their pain they consult their doctor
