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Pain - analgesia overview

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The most effective approach to managing pain is considered to be the use of several different types of analgesics together. This is known as multimodal analgesia.

Using a combination of drugs such as paracetamol, a non-steroidal anti-inflammatory drug and an opiate provides more effective pain relief as the different analgesic drugs affect different parts of the pain pathway. This can increase efficacy while minimizing the dose and therefore the potential for side effects of each drug.

Analgesic Guidelines

The below analgesic guidelines outline the main analgesics used at Starship. The dosing regimens, preparations and considerations for each medication are outlined.   

Analgesia chart 1

Routes of Administration

Oral should be the preferred route of administration, however, majority of the analgesics can be given via alternative routes if oral is not an option. Details of administration routes can be found in the analgesic guidelines above.


Paracetamol is an antipyretic as well as an analgesic but it has no significant anti-inflammatory effect. The action is mainly in the central nervous system. It is useful for mild pain.

Non-Steroidal Anti-Inflammatory Drugs

NSAIDs act mainly at the peripheral nervous system by interfering with the chemicals that sensitise the nerve endings to the pain. They have anti-inflammatory, antipyretic and analgesic properties. These drugs include ibuprofen and diclofenac.
They are effective for mild to moderate pain.


Act mainly in the brain and spinal cord by inhibiting the transmission of pain impulses. They are powerful analgesics.
These include drugs such as tramadol and morphine and are effective for moderate to severe pain.

Two step strategy for pain management

Step 1 (mild pain) Paracetamol and/or NSAID (if not contraindicated)
Step 2 (moderate to severe pain) Paracetamol and/or NSAID (if not contraindicated) and opioid


  • McGrath, J, P., Stevens, J, B., Walker, M, S., & Zempsky, T, W. (2014). Oxford Textbook of Paediatric Pain. Oxford: Oxford University Press.
  • Twycross, A., Dowden, S., & Stinson, J. ( 2014). Managing Pain in Children. A Clinical Guide for Nurses and Healthcare Professionals. West Sussex: John Wiley & Sons, Ltd.

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Document Control

  • Date last published: 24 May 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Pain Service
  • Author(s): Paediatric Pain Service
  • Editor: Greg Williams
  • Review frequency: 2 years

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