The World Health Organization (WHO) analgesic ladder suggests that, if pain persists after a trial with step 2 medications (eg, oxycodone/acetaminophen), then step 3 medications (long-acting opioid agonists) plus nonopioids and adjuvants as appropriate should be tried. Adding a long-acting opioid alone may not be as effective as combining agents; opioids are more effective when combined with nonsteroidal anti-inflammatory drugs. Interventional procedures are indicated in patients who experience inadequate pain control or unacceptable side effects with optimal pharmacologic management.
- Add naproxen, 500 mg twice daily, plus controlled-release oxycodone, 20 mg every 12 hours.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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