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Table 1 Key elements of the MAPP

From: Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design

Element Principles
Multimodal analgesic prescribing Reduced variability between prescribers
Multimodal opioid sparing regime (41,42)
• Strong opioid
• Weak opioid
• NSAID*
• Paracetamol
Analgesics prescribed on a fixed schedule
Assessment of pain Use of 11-point numerical rating scale for pain intensity
Pain intensity rating ≥4 (pain or rest) indicative of breakthrough pain
Frequency of pain intensity assessment
• Two-hourly when awake
• Four-hourly when asleep
• Reassessment of pain intensity within 30 minutes of treatment for breakthrough
Management of breakthrough pain and prevention/control of analgesic side effects Availability of analgesics prescribed as PRN
Algorithmic support for treatment decisions
Availability of pre-emptive treatments for nausea and constipation
Escalation plan if breakthrough pain persists
Review of causation and plan of treatment to prevent recurrence
  1. *non-steroidal anti-inflammatory drugs (NSAID).