The protocol advocated by moveUP is the pain ladder of the WHO.
The three main principles of the WHO analgesic ladder are: “By the clock, by the mouth, by the ladder”.
- By the clock:
- To maintain freedom from pain, drugs should be given “by the clock” or “around the clock” rather than only “on demand”. This means they are given on a regularly scheduled basis. The frequency will depend on whether it is a long- or short-acting preparation.
- By the mouth:
- The oral route is usually the preferred route for ease of use in a variety of care settings.
- By the ladder:
- If pain occurs there should be prompt administration of drugs in the following order until the patient is free of pain:
- non-opiods (e. g. paracetamol)
- as necessary, mild opiods (e. g. codeine)
- then strong opiods (e. g. morphine or hydromorphone)
- If pain occurs there should be prompt administration of drugs in the following order until the patient is free of pain:
Pain medication
At moveUP we believe the rehabilitation should be as pain free as possible for the patient. Pain medication should be prescribed to be given at fixed time intervals with extra doses that can be taken in case of acute pain.
Step 1 medication
Paracetamol
| Type | How many mg | How many | How long | Contra-indications |
| Paracetamol | 1000mg | 1-4/d | 14d postop | • severe liver problems • severe renal impairment |
Nsaid
| Type | How many mg | How many | How long | Contra-indications |
| Diclofenac retard (NSAID) | 75mg | 2/d 1/d | 14d postop 14-30d postop To be gradually diminished based on inflammation parameters. | • stomach ulcers • renal impairment |
| OR | ||||
| Etoricoxib (Arcoxia) | 60mg | 2/d | 10 days postop | • stomach ulcers • renal impairment |
Step 2: weak opioid
| Type | How many mg | How many | How long | Contra-indications |
| Tramadol (Contramal) | 50 mg | 1-3/d | when in severe pain |
Step 3: strong opiod
| Type | How many mg | How many | How long | Contra-indications |
| Oxycodon | 5mg | 1-3/d | when in severe pain not controlled by tramadol |