INCIDENT PAIN PROTOCOL
St. Boniface General Hospital
Palliative Care
Dr. Mike Harlos
Step Medication # micrograms SL
(50 microgm/ml)
1 Fentanyl 50
2 Sufentanil 25
3 Sufentanil 50
4 Sufentanil 100
Application of Incident Pain
Protocol:
Examples of situations in which
the Incident Pain Protocol
is initiated:
– planned turns
– transfers
– bathing
– changing clothes
– dressing changes
– disimpaction
* The opioid (fentanyl or
sufentanil) is administered
sublingually 10 min prior to
anticipated activity
* If the initial dose appears to be
insufficient, that same
dose may be repeated up to two
further doses, at 10 minute
intervals.
* If a given dose is sufficient, the
patient will typically
appear drowsy 10 – 15 min.
following the dose. If this is
not the case, or if the patient
experiences discomfort
during the planned activity, then
repeat doses may be
given as above.
* Increasing to the next step of the
Incident Pain Protocol
is undertaken if the maximum
number of doses (three) is
required to achieve comfort, or is
insufficient to achieve
comfort with activity. Increasing to
the next step of the
Incident Pain Protocol cannot be
done within one hour of
the most recent fentanyl or
sufentanil dose, except after
contacting the physician. If the
maximum number of doses
(three) has been given, and the
patient remains in
discomfort with activity that must
be undertaken
presently, the physician should be
contacted for
consideration of immediately
proceeding to the next step
of the Incident Pain Protocol
* The Incident Pain Protocol may
be used up to q 1h prn
