Stevens-Johnson Syndrome: What to Do When Initial Pain Management Is Insufficient
Stevens-Johnson syndrome (SJS/TEN) causes severe cutaneous pain that can persist despite first-line analgesic measures. When validated pain assessment shows that initial mild analgesics have not achieved adequate pain control, a defined escalation protocol applies.
Previous Treatment — Failure Condition
Initial supportive care included regular paracetamol (acetaminophen) supplemented as needed with oral codeine or tramadol. The trigger for escalation is failure to achieve controlled cutaneous pain, as measured by a validated pain tool.
Next-Step Treatment (Partial Overview)
When pain persists beyond what mild analgesics can control, the protocol escalates to a stronger class of analgesic agents. Delivery route and monitoring schedule vary by clinical circumstances and are fully defined in the structured protocol.
Full agent selection, route, and monitoring details are in the complete regimen — not shown here.
Clinical Target
Control of cutaneous pain, re-evaluated with the pain score on a 4-hourly basis.
References
- If the pain score equates to moderate or severe pain then prescribe regular opiate-based analgesia (e.g. morphine or fentanyl) delivered enterally, or by PCA, or via infusion.
- In patients needing opiate-based analgesia, pain should be re-evaluated using the pain score on a 4-hourly basis and prior to any intervention.
DOI: 10.1111/bjd.14530Digital
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