Pain Control in Austere Environment - Dr. Wedmore

Pain Control is Important -
where ever you go!!

• But when you are in difficult environments with sparse resources, what you bring is important!
• The therapy needs to be:

1. Lightweight
2. Stable when not refrigerated.
3. EFFICACIOUS!
4. Have low side-effect profile (you really don't want to make things worse).
   

Some Pain Control Options

• Non-Pharm

1. Placebo Effect and Empathy are POWERFUL!! You have a powerful Placebo Effect... use this power!!
   
2. RICE does work.
3. Delayed heat (100-104 degree) - Decreases GABA fiber.
4. Acupuncture - Actually has been proven to help with pain (acupuncture needles are easy to pack)
5. Plants/herbs - BE CAREFUL!  Be 100% certain you know what you are dealing with.
   

• Pharm

1. APAP and Ibuprofen - Can be taken together for synergestic effect.
2. Military uses Meloxicam - 90% Cox2 so no platelet inhibition for young healthy (low risk of renal failure).
3. Fentanyl intranasal or lollipop - 800 micrograms lozenge taped to finger in case of falling asleep
4. Ketamine - 1/10th dissociative dose (0.1 mg/kg), not a controlled drug, minimal side effects at low dose, opioid sparing effect.  Don't give if hx of schizophrenia. 
5. Local anesthetics and regional blocks - If you only have room for one, grab Bupivacaine.
   

WE can use ketamine here for pain control...talk to the nurses before you order it though... it might be misunderstood.