As with other medicines, drugs used for pain relief can be given by various methods and can cause side effects. This section lists some drugs commonly used to relieve pain. Many other drugs are used to relieve pain in children, including acetaminophen, nalbuphine, fentanyl, hydrocodone, and others.

Pain medication list

Several different names can be used to refer to each of the pain medications. You may hear the same drug referred to by its generic name, an abbreviation, or one of several brand names, depending on which doctor, nurse, or pharmacist you talk to. The list below provides the generic name of several commonly used pain medications and some of the most common brand names.

Codeine

How given: IM injection; IV injection or infusion; subcutaneous injection; pills or liquid by mouth

Note: People who cannot metabolize codeine get no pain relief from this drug (see section earlier in this chapter called “Different Responses to Medications”). Codeine should not be given to children younger than age 12.

Common side effects:

• Light-headedness
• Dizziness
• Sedation
• Euphoria
• Constipation

Hydromorphone

How given: IV injection or infusion; pill by mouth; subcutaneous injection

Precaution: It can cause slowed breathing.

Common side effects:

• Dizziness and light-headedness
• Sedation
• Nausea and vomiting
• Excessive sweating
• Euphoria and other mood alterations
• Headaches
• Constipation
• Slowed breathing

Meperidine

How given: IV, IM, or subcutaneous injection; liquid or pill by mouth. It is not as effective if taken by mouth.

Common side effects:

• Sedation
• Constipation
• Dizziness
• Nausea and vomiting
• Dry mouth
• Flushing or sweating

Morphine

How given: IV injection or infusion; pill by mouth (long-acting or short-acting); liquid by mouth

Common side effects:

• Euphoria
• Nausea and vomiting
• Sedation
• Dry mouth
• Headaches
• Drowsiness
• Constipation

Oxycodone

How given: Pills or liquid by mouth

Common side effects:

• Light-headedness
• Dizziness
• Sedation
• Constipation
• Nausea and vomiting

Topical anesthetics to prevent pain

Several products are commonly used to prevent pain from injections, finger pricks, and IV insertions. Most fall into two categories, which are described below. Use of these drugs is also discussed in Chapter 9, Coping with Procedures.

Topical anesthetizing creams

Examples: EMLA®, ELA-Max®, and many other brand names

How given: Each product has slightly different instructions. In general, they are applied to the skin 30 to 90 minutes before a procedure. Some must be covered with an airtight dressing.

How they work: These creams contain the topical anesthetic lidocaine. ELA-Max® uses lidocaine alone; EMLA® uses lidocaine in combination with prilocaine.

Notes: It may take longer than an hour to achieve effective anesthesia in dark-skinned children. When using EMLA®, the blood vessels sometimes constrict, making it harder to find a vein. To prevent this problem, it helps to apply a warm damp cloth right before the injection.

We use EMLA® for everything: finger pokes, accessing port, and shots. I even let her sister use it for shots because it lets her get a bit of attention, too. Both of my children have sensitive skin that turns red when they pull off tape, so I cover the EMLA® with plastic wrap held in place with paper tape. I also fold back the edge of each piece of tape to make a pull tab so the kids don’t have to peel each edge back.

Vapocoolant sprays

Examples: Fluori-Methane Spray® and Fast Freeze®

How given: These aerosol sprays are applied to the target area right before the procedure. They can also be applied by spraying the solution into a medicine cup for 10 seconds, then dipping a cotton ball into the solution and holding it on the site for 15 seconds right before the procedure.

How they work: Most vapocoolant sprays use the refrigerant ethyl chloride to numb the area before an injection or infusion.

Note: If the spray is applied for too long, it can cause frostbite. Spray just until skin begins to turn white (3 to 10 seconds). The spray can should be held between 3 to 9 inches away from the skin.