ABSTRACT
While the clinician’s attention to pain may come naturally for patients manifesting more visible injuries, providers often hesitate before administering analgesics to patients with neurologic injury for several reasons. In the setting of neurologic injury where the overall level of arousal may be impaired, opioids specifically can depress the patient’s level of consciousness and mask the neurologic exam to prevent the accurate assessment of neurologic injury. Therefore, it is apparent that pain management in this population is challenging and a multimodal analgesic strategy is paramount. This chapter reviews pain management in trauma, operative, and critical care settings related to patients with neurotrauma. In addition to standard dosing recommendations, adverse drug reactions and monitoring parameters of commonly used analgesic agents are described. Finally, we have reviewed management of opioid withdrawal and treatment of pain in patients with a history of opioid dependence.
