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Management of Acute Pain After An Emergency Department Visit:
 Acetaminophen (Tylenol) 1,0000 mg every 6 hours as needed  Acetaminophen (Tylenol) 1,0000 mg every 6 hours  AND Ibuprofen (Advil) 600 mg every 6 hours as needed for breakthrough pain  Acetaminophen (Tylenol) 1,000 mg every 6 hours  AND Ibuprofen (Advil) 600 mg every 6 hours  AND Narcotics as needed for breakthrough pain o ie. Morphine 1-2 tablets every 4 hours as needed Follow Up: make an appointment to see your Family Doctor within 3-5 days to determine your need Side Effects (see product monograph for a complete listing, talk to your pharmacist or Family Doctor to ensure these medications are safe to take with any other medications you take):  Acetaminophen has very few side effects and is one of the safest pain medication, by
continuing to use it on Steps 2 & 3 of the ladder you will significantly decrease your need for the other medications which have much more significant side effects. Avoid other medications such as cold preparations or Tylenol #3 that also contain acetaminophen, because you risk exceeding the maximum total allowable dose of acetaminophen (4,0000 mg per day).  Ibuprofen is fairly safe when used for short periods of time (less than 5 days), it does
increase your risk of ulcers / gastrointestinal bleeding, should not be used by patients with impaired kidney function and tends to cause stomach upset. Avoid other similar pain medications (Aspirin, Naproxen, Indomethacin, Ketorolac [Torradol], Diclofenac.consult your pharmacist). If you require Ibuprofen for longer than 5 days speak with your family doctor about the risks / benefits of continuing with Ibuprofen and if you should be on an additional medication to decrease your risk of stomach ulcer.  Narcotics have many troublesome side effects and ideally should be used for as short a time
as possible. Major side effects include: o Drowsiness: you cannot operate a motor vehicle, exposed yourself to risk (ie. climbing a ladder) or make important decisions while taking narcotics. o Constipation: narcotics will slow down your bowels and prevent normal emptying unless you increase your fluid and fiber intake, you may also need to take a laxative such as Senokot (Talk to your pharmacist or Google: "BCCA Suggestions for Dealing With Constipation") o Dependence & Addiction: the risk of addiction and dependence is very low if narcotics are used properly over a short period of time to treat acutely painful conditions. o Overdose: if you were to take an overdose of your narcotic medications you may stop  If you find that your pain is becoming intolerable by 6 hours you can try staggering your medication, that way you will get some additional pain relief every 3 hours. For example: o Noon: Acetaminophen 1,000 mg o 3pm: Ibuprofen 600 mg o 6pm: Acetaminophen 1,000mg o 9pm: Ibuprofen 600 mg  If narcotics are required to control your pain, it may be helpful to use them more at night and less during the day. This may help keep you on a normal sleep cycle and minimise your

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