Patent Publication Number: US-9842512-B2

Title: Device and method for tapering medications in post-operative patients

Description:
This application is a continuation of U.S. patent application Ser. No. 13/788,590, filed on Mar. 7, 2013; the entirety of which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to the administration of medication in post-operative patients and in particular to a device and method for tapering the medication safely and with minimal side effects. 
     BACKGROUND OF THE INVENTION 
     Solutions to managing pain are known. However, the management of post-operative pain in children is an art and a science that has yet to be perfected. While research findings differ widely on medications, methods, and timing of interventions to manage post-operative pain, one finding is consistently reported: the treatment of pediatric post-operative pain is suboptimal. Reasons for this deficiency originate in biases of clinicians and parents, difficulties in assessing pain due to variances in physical and developmental levels of children, and lack of research in best practices for pediatric pain management. Because hospital stays are reduced, parents or caregivers must often manage this pain at home. Therefore, educating these primary caregivers in the safe, effective use of pain medications, the reduction of side effects, and the appropriate tapering of the medications is paramount. It is also complex and multifaceted. Preferred methods of patient education are under much scrutiny and the needs of this group of learners are extensive. It is not enough to teach on just the cognitive level. Psychosocial, cultural, and environmental factors impact both the learning and the perceived need for managing children&#39;s post-operative pain management at home. Presently, a learning device that addresses these barriers and provides a simple guide for medication management is not available. 
     While all patients, adult and pediatric, need such a learning device, children are at unique risk for the under treatment of pain because they lack the verbal ability and personal power to demand adequate pain management, and they often do not understand the reason for their suffering. This increased risk poses the single greatest reason for focusing on pain management for this special group of patients. Compounding this risk are the frequent experiences with pain due to the necessity of repeated and ongoing interventions. 
     The three primary types of pain are nociceptive, inflammatory, and pathological. The post-operative pain generally referred to in this paper is inflammatory pain. Inflammatory pain assists in the healing of the injured body part by creating a situation that discourages physical contact and movement, which reduces further risk of damage and promotes recovery. This type of pain is activated by the immune system and although considered adaptive, reduction in this pain is still vital. Untreated or poorly controlled pain can acutely lead to tachycardia, hypertension, decrease in alveolar ventilation, insomnia, and poor wound healing. Unrelieved acute pain can lead to chronic complications such as chronic pain, sustained changes in central neural functioning, and psychological problems such as heightened pain intensity, anxiety, and post-traumatic stress. In fact it is well known that inadequate treatment of pain contributes to higher rates of complications and lower quality of life and is the most common reason people present for health care. Pain costs society billions of dollars annually, and pain can have a widespread impact on all aspects of life. Despite its recognized significance and the volumes of research dedicated to its management, pain continues to be undertreated especially in children. 
     As hospital stays following inpatient surgeries become shorter, parents of these children must also learn to manage post-operative pain at home in a shorter period of time. While children are hospitalized, hospital staff use a multimodal approach to pain management employing such techniques as local and regional analgesia, intravenous and intramuscular pain medications, patient controlled analgesia (PCA) techniques, continuous epidural anesthesia and multiple adjunctive agents. Parents at home do not have access to most of these modalities. Therefore, the medications and non-pharmacological techniques for managing post-operative care at home must be used to their utmost effectiveness in order to manage this pain. Because most of these caregivers are not health care professionals, these parents must be taught to be skilled caregivers and knowledgeable pharmacological providers for their children after discharge. 
     Therefore, what is needed is a device and method that assists post-operative patients and families in the timing, the dosing, and, ultimately, the elimination of pain medications. In particular a simple tool and method are needed that reduce pain and discomfort; maximize health and function; minimize complications and side effects; and allows the patient to taper off medication in a safe manner by assisting in planning pain medication times and in reducing medication usage over time. 
     BRIEF SUMMARY OF THE INVENTION 
     The shortcomings of conventional therapies are addressed by the device and method for tapering medications in accordance with the invention. 
     The novel invention includes the use of a taper wheel that assists post-operative patients and their families in the timing, the dosing, and, ultimately, the elimination of pain medications. 
     In one aspect of the invention three concentrically placed wheels with indicia thereon are provided. 
     In another aspect of the invention a 12-hour wheel with three concentrically placed wheels with indicia thereon are provided. 
     In a further aspect of the invention a writeable base in provided upon which the taper wheel in accordance with the invention is positioned. 
     In another aspect of the invention a 24-hour taper wheel with two concentrically placed wheels with indicia thereon positioned on a writeable base is provided. 
     In another aspect of the invention a method for using the taper wheel is provided. 
     While multiple embodiments, features and advantages are disclosed, still other embodiments of the invention will become apparent to those skilled in the art from the following detailed description taken together with the accompanying figures, the foregoing being illustrative and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For a better understanding of the invention, and to show how the same may be carried into effect, reference will now be made, by way of example, to the accompanying drawings, in which: 
         FIG. 1  is a perspective view of a taper wheel in accordance with the invention. 
         FIG. 2  is a perspective view of a 12-hour taper wheel in accordance with the invention. 
         FIG. 3  is a perspective view of a 12-hour taper wheel including instructions on a writeable base. 
         FIG. 4  is a perspective view of a 24-hour taper wheel including instructions on a writeable base. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The management of pediatric pain is interdependently complex. Various components such as education, family and provider biases, underlying differences in individual pain, cultural differences, and more are all interwoven into a puzzle that must be sorted and pieced together. A final piece of this puzzle involves the actual pain medications, their dosing, and timing for postoperative pain management at home. 
     World Health Organization (WHO) guidelines for pain management may be used for acute and chronic pain in any patient that requires analgesics. The WHO standard protocol includes (i) using the oral form of the analgesic; (ii) giving analgesics at regular intervals; (iii) prescribing analgesics according to pain intensity based on pain assessment; (iv) providing analgesic dose based on the individual; and (v) prescribing analgesics with a regularity of administration. Pain management may be improved by recognizing and treating pain promptly (emphasis on comprehensive assessment and the importance of preventive and prompt treatment); involving patients and families in pain management plan (emphasis on customization of care and participation of patient in the treatment plan); improving treatment patterns (eliminate inappropriate practices, provide multimodal therapy); reassessing and adjusting pain management plan as needed (respond not only to pain intensity but to functional status and side effects; and monitoring processes and outcomes of pain management (standardized quality indicators). It is with the foregoing in mind that the present invention was developed. 
     The present invention may document pain intensity with a numeric or descriptive rating scale and at frequent intervals. Pain may be treated with regularly scheduled analgesics. A multimodal approach is used whenever possible (combinations of techniques). Pain may thus be prevented or controlled to increase function and quality of life. Further, patients should be adequately informed about pain management. Thus, effective patient education is needed. 
     Dosing guidelines may also be developed to promote the maintenance of therapeutic blood levels of analgesic and the prevention of pain when possible. In other words, scheduled or around-the-clock (ATC) dosing is preferred to pro re nata (PRN) dosing because it has been found to be more effective in reducing pain intensity despite the fact that analgesic quantities may be greater in ATC patients than in PRN patients. 
     The issue of withdrawal symptoms for any post-operative patient on an opioid or benzodiazepine medication must also be taken into consideration. Withdrawal syndrome is a characteristic pattern of unpleasant signs and symptoms that typically follows abrupt cessation of drugs with central nervous system depressant effects. Predominant characteristics of this syndrome include nervous system hyperirritability, autonomic dysregulation (sneezing, yawning, sweating, tachycardia), gastrointestinal dysfunction, respiratory distress, and abnormal motor movements. Studies have documented withdrawal syndrome in infants and children since the 1980s and symptoms have been seen in patients on as few as five days of ATC opioid and benzodiazepine regimens. There is no current consensus on how opioid and benzodiazepine medications should be discontinued to prevent withdrawal syndrome or how this syndrome should be treated. However, the present inventor has found that a tapering management protocol including the novel taper wheel leads to gradual discontinuation of these medications and lessens withdrawal symptoms. 
     Typically, patients having had a surgical procedure usually resulting in significant pain and muscle spasms receive adequate pain control during their hospital stay, often with an epidural opioid medication. After a few days, patients are transitioned to oral narcotic medications (oxycodone or percocet) and antispasmotics (valium, vistaril). While this is a complicated medication schedule, it is managed by nurses and most patients report good pain control during their hospital stay. The problem arises when patients are sent home, as they commonly are, on these medications. Current protocol, varies among institutions, but typically consists of providing families with a packet of written papers about the medications, follow-up appointments, physical restrictions, cast care, and dietary and bathing instructions. In addition, the inpatient nurses provide verbal instructions. Given the volume of information and the time limitations of the nurses, it is not difficult to understand why many families have difficulty learning and maintaining this complex medication schedule. 
     To address these issues, the Taper Wheel and associated method of use was created by the present inventor with the aim of providing effective and safe acute post-operative pain management to children in their homes with the primary goals of reducing pain and discomfort; maximizing health and function; and minimizing complications and side effects. An important secondary goal is tapering off the pain and antispasmodic medications in a safe manner. 
     Referring now to  FIG. 1 , a perspective view of a taper wheel  100  in accordance with the invention is illustrated. The taper wheel is a hand-held device that assists in planning medication times and helps to reduce pain medication usage over time. It is especially designed for use with opioid and benzodiazepine medications but those of skill in the art will appreciate that it can be adapted for adults and patients on other types of pain medication. In addition, those of skill in the art will appreciate that taper wheel may include any number of wheels depending on the number of different medications a patient is taking. 
     Taper wheel  100  broadly includes a stationary base  112 , a first medication wheel  114  denominated as a “pain” wheel and a second medication wheel  116  denominated as a “spasm” wheel. For ease of explanation and disclosure this specification will refer to the wheels as “pain” and “spasm” wheels although one of skill in the art will appreciate that the taper wheel in accordance with the invention may include wheels for different medications other than pain and spasm and may include more or fewer wheels than depicted. Such variations are intended to fall within the scope of the present invention. The base wheel  112  is in the form of a clock and includes numerals 1 through 12 representing a twelve hour cycle. Those of skill in the art will appreciate that additional time increments, for example 15 minute or 30 minute increments, may be included on the base wheel  112  without departing from the scope of the invention. 
     The taper wheel  100  in accordance with the invention includes a stationary substantially round base  112 , a concentrically placed inner pain wheel  114  and a concentrically placed outer spasm wheel  116 . Those of skill in the art will appreciate that wheels  114  and  116  are designed to individually rotate 360 degrees about a centrally placed pin  118  and stationary round base  112 . Pain wheel  114  is used to calculate medication times and dose for pain medications and spasm wheel  116  is used to calculate medication times and doses for spasm medication. The taper wheel depicted in  FIG. 1  is designed for calculating medication times and doses within a defined period of time, twelve hours as depicted, with the goal of extending the times of administration gradually. Those of skill in the art will appreciate that pain wheel  114  and spasm wheel  116  may be different colors to clearly distinguish which medication, pain or spasm medication, they represent. In addition, the wheels may be constructed of a whiteboard or other material on which a patient or a caregiver could write nonpermanent markings such as the names of the medications or other information. In this way, the taper wheels are usable. Suitable materials include but not limited to melamine, painted steel or aluminum, laminates, porcelain on steel or aluminum, polyethylene terephthalate (PET) on steel or aluminum and laminated cardstock. 
     Referring again to  FIG. 1  stationary base  112  includes numerical indicia thereon  110 . More specifically, stationary base is in the form of a “clock” having a defined time period of 12-hours with numerals from 1 to 12 indicating the particular hour. Pain wheel  114  may also include indicia thereon, as will hereinafter be described. Pain wheel  114  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that medications may be given. Because pain and spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  122 ,  126  and  127  which represent 4 hour, 5 hour and 6 hour intervals, respectively. Lines  122 ,  126  and  127  may be of different colors or may include different indicia (as best seen in  FIG. 3 ) to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. Moreover, those of skill in the art will appreciate that medications and similar chemical compounds may be administered to a patient orally, topically or by injection and all forms of administration are intended to be within the scope of the invention. 
     Arrow  121  is always the “start” for calculating planned medication times. Line  122  represents a four-hour medication cycle and the numeral “4” may be denoted on the left-hand side of line  222  to easily indicate to the caregiver a four-hour medication cycle. Corresponding to line  122  are two additional four-hour interval lines  123 ,  124  positioned in a four hour and eight hour spaced apart relationship to line  122 , respectively. 
     Second line  125  may be a different color than first line  122  to distinguish between them. The numeral “5” is written on the pain wheel  114  and positioned to the right of the second line to easily indicate to a caregiver a five-hour medication cycle. Corresponding to five-hour line  125  is a second five-hour line  126  in a five hour spaced-apart relationship to line  125  on pain wheel  114 . 
     Third line  127  may be a different color than the first lines  122 ,  123 ,  124  or second lines  125 ,  126  to distinguish among them. The numeral “6” is written on the pain wheel  114  and may be positioned to the left of third line  127  to easily indicate to the caregiver a six-hour medication cycle. Corresponding to third line  127  is one additional six-hour line  128  which is positioned on pain wheel  114  in a six-hour spaced-apart relationship to line  127  on pain wheel  114 . Those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the pain wheel may change and, therefore, are illustrative and not limiting. 
     Spasm wheel  116  is similar to pain wheel  114 . Spasm wheel  116  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that spasm or other medication may be given to a post-operative patient. Because spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  122 ′,  126 ′ and  127 ′ which represent 4 hour, 5 hour and 6 hour intervals for the administration of spasm medication, respectively. Lines  122 ′,  126 ′ and  127 ′ may be of different colors or may include different indicia (as best seen in  FIG. 3 ) to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines on the spasm wheel representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  121 ′ is always the “start” for calculating planned spasm medication times. Line  122 ′ includes the numeral “4” denoted on the left-hand side of line  122 ′ to easily indicate to the caregiver a four-hour spasm medication cycle. Corresponding to line  122 ′ are two additional four-hour interval lines  123 ′,  124 ′ positioned in a four hour and eight hour spaced apart relationship to line  122 ′, respectively. 
     Second line  125 ′ may be a different color than first line  122 ′ to distinguish between them. The numeral “5” is written on the spasm wheel  114 ′ and positioned to the right of the second line to easily indicate to a caregiver a five-hour medication cycle. Corresponding to five-hour line  125 ′ is a second five-hour line  126 ′ in a five hour spaced-apart relationship to line  125 ′ on pain wheel  114 ′. 
     Third line  127  may be a different color than the first lines  122 ,  123 ,  124  or second lines  125 ,  126  to distinguish among them. The numeral “6” is written on the pain wheel  114  and may be positioned to the left of third line  127  to easily indicate to the caregiver a six-hour medication cycle. Corresponding to third line  127  is one additional six-hour line  128  which is positioned on pain wheel  114  in a six-hour spaced-apart relationship to line  127  on pain wheel  114 . 
     As with the pain wheel  114  above, those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the spasm wheel may include additional time periods or fewer time periods and, therefore, are illustrative and not limiting. 
     Referring now to  FIG. 2  an aspect of a taper wheel  200  in accordance with the invention includes a stationary substantially round base  212 , a concentrically placed inner pain wheel  214  and a concentrically placed outer spasm wheel  216 . Those of skill in the art will appreciate that wheels  214  and  216  are designed to individually rotate 360 degrees about a centrally placed pin  218  and stationary round base  212 . Pain wheel  214  is used to calculate medication times and dose for pain medications and spasm wheel  216  is used to calculate medication times and doses for spasm medication. The taper wheel depicted in  FIG. 2  is designed for calculating medication times and doses within a defined period of time, twelve hours as depicted, with the goal of extending the times of administration gradually. Those of skill in the art will appreciate that pain wheel  214  and spasm wheel  216  may be different colors to clearly distinguish which medication, pain or spasm medication, they represent. In addition, the wheels may be constructed of a whiteboard or other material on which a patient or a caregiver could write nonpermanent markings such as the names of the medications or other information. In this way, the taper wheels are usable. Suitable materials include but not limited to melamine, painted steel or aluminum, laminates, porcelain on steel or aluminum, polyethylene terephthalate (PET) on steel or aluminum or laminated card stock. 
     Referring again to  FIG. 2  stationary base  212  includes numerical indicia thereon  210 . More specifically, stationary base is in the form of a “clock” having a defined time period of 12-hours with numerals from 1 to 12 indicating the particular hour. Pain wheel  214  also includes indicia thereon, as will hereinafter be described. Pain wheel  214  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that medication may be given. Because pain and spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  222 ,  226  and  227  which represent 4 hour, 5 hour and 6 hour intervals, respectively. Lines  222 ,  226  and  227  may be different colors or may include different indicia (as best seen in  FIG. 3 ) to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  221  is always the “start” for calculating planned medication times. Line  222  includes the numeral “4” denoted on the left-hand side of line  222  to easily indicate to the caregiver a four-hour medication cycle. Corresponding to line  222  are two additional four-hour interval lines  223 ,  224  positioned in a four hour and eight hour spaced apart relationship to line  222 , respectively. 
     Second line  225  may be a different color than first line  222  to distinguish between them. The numeral “5” is written on the pain wheel  214  and positioned to the right of the second line to easily indicate to a caregiver a five-hour medication cycle. Corresponding to five-hour line  225  is a second five-hour line  226  in a five hour spaced-apart relationship to line  225  on pain wheel  214 . 
     Third line  227  may be a different color than the first lines  222 ,  223 ,  224  or second lines  225 ,  226  to distinguish among them. The numeral “6” is written on the pain wheel  214  and may be positioned to the left of third line  227  to easily indicate to the caregiver a six-hour medication cycle. Corresponding to third line  227  is one additional six-hour line  228  which is positioned on pain wheel  214  in a six-hour spaced-apart relationship to line  227  on pain wheel  214 . Those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the pain wheel may change and, therefore, are illustrative and not limiting. 
     Spasm wheel  216  is similar to pain wheel  214 . Spasm wheel  216  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that spasm or other medication may be given to a post-operative patient. Because spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  222 ′,  226 ′ and  227 ′ which represent 4 hour, 5 hour and 6 hour intervals for the administration of spasm medication, respectively. Lines  222 ′,  226 ′ and  227 ′ may be of different colors or may include different indicia (as best seen in  FIG. 3 ) to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines on the spasm wheel representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  221 ′ is always the “start” for calculating planned spasm medication times. Line  222 ′ represents a four hour line and the numeral “4” is denoted on the left-hand side of line  222 ′ to easily indicate to the caregiver a four-hour spasm medication cycle. Corresponding to line  222 ′ are two additional four-hour interval lines  223 ′,  224 ′ positioned in a four hour and eight hour spaced apart relationship to line  222 ′, respectively. 
     Second line  225 ′ may be a different color than first line  222 ′ to distinguish between them. The numeral “5” is written on the spasm wheel  214 ′ and positioned to the right of the second line to easily indicate to a caregiver a five-hour medication cycle. Corresponding to five-hour line  225 ′ is a second five-hour line  226 ′ in a five hour spaced-apart relationship to line  225 ′ on pain wheel  214 ′. 
     Third line  227 ′ may be a different color than the first lines  222 ′,  223 ′,  224 ′ or second lines  225 ′,  226 ′ to distinguish among them. The numeral “6” is written on the spasm wheel  216  and may be positioned to the left of third line  227 ′ to easily indicate to the caregiver a six-hour medication cycle. Corresponding to third line  227 ′ is one additional six-hour line  228 ′ which is positioned on spasm wheel  216  in a six-hour spaced-apart relationship to line  227 ′ on spasm wheel  216 . 
     As with the pain wheel  214  above, those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the spasm wheel may change and, therefore, are illustrative and not limiting. 
     Referring now to  FIG. 3  another aspect of the taper wheel in accordance with the invention is shown. The taper wheel  300  includes a stationary base  312 , and two concentrically placed wheels thereon, a pain wheel  314  and a spasm wheel  316 . Pain wheel  314  and spasm wheel  316  are rotatably joined by pin  318  to each other and to base  312 . Stationary base  312  may include a variety of information  330  thereon such as instructions for use, medication and dose and/or a key for understanding the lines on the taper wheel  300 . Stationary base  312  also includes numerical indicia thereon. More specifically, stationary base  312  includes written indicia in the form of a clock defining a time period of 12-hours with numerals from 1 to 12 and surrounding pain wheel  314 . 
     Pain wheel  314  also includes indicia thereon, as will hereinafter be described. Pain wheel  314  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that medication may be given. Because pain and spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  322 ,  326  and  327  which represent 4 hour, 5 hour and 6 hour intervals, respectively, and as indicated in “key”  332 . Lines  322 ,  326  and  327  may be of different colors or may be include different indicia as seen in  FIG. 3  to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  321  is always the “start” for calculating planned medication times. Key  332  indicates that line  322  (and  323 ,  324 ) are four hour interval lines for administering medication. Corresponding to line  322  are two additional four-hour interval lines  323 ,  324  positioned in a four hour and eight hour spaced apart relationship to line  322 , respectively. 
     Second line  325  may be a different color than first line  322  to distinguish between them or may be identified with different indicia as seen in  FIG. 3 . Key  332  indicates to the caregiver that line  325  identifies a five-hour medication cycle. Corresponding to five-hour line  325  is a second five-hour line  326  in a five hour spaced-apart relationship to line  325  on pain wheel  314 . 
     Third line  327  may be a different color than the first lines  322 ,  323 ,  324  and second lines  325 ,  326  to distinguish among them. As with the four and five hour medication interval lines, key  332  identifies line  327  to the caregiver as a six-hour medication cycle. Corresponding to third line  327  is one additional six-hour line  328  which is positioned on pain wheel  314  in a six-hour spaced-apart relationship to line  327  on pain wheel  314 . Those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the pain wheel may change and, therefore, are illustrative and not limiting. 
     Spasm wheel  316  is similar to pain wheel  314 . Spasm wheel  316  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that spasm or other medication may be given to a post-operative patient. Because spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  322 ′,  326 ′ and  327 ′ which represent 4 hour, 5 hour and 6 hour intervals for the administration of spasm medication, respectively. Lines  322 ′,  326 ′ and  327 ′ may be of different colors or may be include different indicia as seen in  FIG. 3  to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines on the spasm wheel representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  321 ′ is always the “start” for calculating planned spasm medication times. Key  332  identifies line  322 ′ to the caregiver as a four-hour spasm medication cycle. Corresponding to line  322 ′ are two additional four-hour interval lines  323 ′,  324 ′ positioned in a four hour and eight hour spaced apart relationship to line  322 ′, respectively. 
     Second line  325 ′ may be a different color than first line  322 ′ to distinguish between them. Key  332  indicates to a caregiver that line  325 ′ represents a five-hour medication cycle. Corresponding to five-hour line  325 ′ is a second five-hour line  326 ′ in a five hour spaced-apart relationship to line  325 ′ on spasm wheel  316 ′. 
     Third line  327 ′ may be a different color than the first line  322 ′ to distinguish between them. Once again, key  332  identifies line  327 ′ as a six-hour medication cycle. Corresponding to third line  327 ′ is one additional six-hour line  328 ′ which is positioned on spasm wheel  316  in a six-hour spaced-apart relationship to line  327 ′. 
     As with the pain wheel  314  above, those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the spasm wheel may change and, therefore, are illustrative and not limiting. 
     Referring now to  FIG. 4  another aspect of a taper wheel  400  in accordance with the invention is shown. Taper wheel  400  is designed for calculating medication administration times in a 24-hour period with the goal of extending the times of administration gradually thus tapering the patient off the medication. 
     The taper wheel  400  is substantially similar to the taper wheel  300  of  FIG. 3  and includes a stationary base  412 , and two concentrically placed wheels, a pain wheel  414  and a spasm wheel  416 . Pain wheel  414  and spasm wheel  416  are rotatably joined by pin  418  to each other and to base  412 . Stationary base  412  may include a variety of information thereon such as instructions for use  430 , current medications  432  and/or a key  432  for understanding the lines on the taper wheel  400 . Those of skill in the art will appreciate that base  412  may contain less information or more information. Stationary base  412  also includes numerical indicia thereon corresponding to a twenty-four hour time period with numerals from 1 a.m. to 12 p.m. and from 1 p.m. to 12 a.m. The twenty-four hour numerals surround pain wheel  414 . Those of skill in the art will appreciate that the taper wheels  100 ,  200 ,  300  of  FIGS. 1 through 3  may also be configured as twenty-four hour taper wheels. 
     Pain wheel  414  also includes indicia thereon, as will hereinafter be described. Pain wheel  414  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that medication may be given. Because pain and spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  422 ,  426  and  427  which represent 4 hour, 5 hour and 6 hour intervals, respectively, and as indicated in “key”  432 . Lines  422 ,  426  and  427  may be of different colors or may be include different indicia as seen in  FIG. 3  to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  421  is always the “start” for calculating planned medication times. Key  432  indicates that line  422  (and  423 ,  424 ,  522 ,  523 ,  524 ) are four hour interval lines for administering medication. Four-hour interval lines  423 ,  424 ,  522 ,  523  and  524  are positioned in a four hour spaced apart relationship to the preceding four-hour line. 
     Second line  425  may be a different color than first line  422  to distinguish between them or may be identified with different indicia as seen in  FIG. 3 . Key  432  indicates to the caregiver that line  425  identifies a five-hour medication cycle. Corresponding to five-hour line  425  are five-hour lines  426 ,  525  and  526  each in a five hour spaced-apart relationship from the preceding five-hour line on pain wheel  414 . 
     Third line  427  may be a different color than the four hour line series  422 , etc. and five-hour line series  425 , etc. to distinguish among them. As with the four and five hour medication interval lines, key  432  identifies line  427  to the caregiver as a six-hour medication cycle. Corresponding to third line  427  are additional six-hour lines  428 ,  527  and  528  which is positioned on pain wheel  414  in a six-hour spaced-apart relationship from the preceding six-hour line on pain wheel  414 . Those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the pain wheel may change to include additional time intervals or fewer time intervals and, therefore, are illustrative and not limiting. 
     Spasm wheel  416  is similar to pain wheel  414 . Spasm wheel  416  includes a variety of lines painted or otherwise indicated thereof. The lines represent different time intervals that spasm or other medication may be given to a post-operative patient. Because spasm medications are typically given at 4, 5 and 6 hour intervals, three exemplary distinct lines are depicted as  422 ′,  426 ′ and  427 ′ which represent 4 hour, 5 hour and 6 hour intervals for the administration of spasm medication, respectively. Lines  422 ′,  426 ′ and  427 ′ may be of different colors or may be include different indicia as seen in  FIG. 4  to distinguish them from each other. Those of skill in the art will appreciate that any number of mechanisms may be used to distinguish between the three lines and still be within the scope of the invention. Those of skill in the art will also appreciate that the taper wheel may be modified to include additional lines on the spasm wheel representing additional time intervals such as 2 hours, 3 hours, 7 hours, 8 hours and the like without departing from the scope of the invention. In addition, lines representing time intervals other than hourly may be included such as half-hourly, quarterly, etc. 
     Arrow  421 ′ is always the “start” for calculating planned spasm medication times. Key  432  identifies line  422 ′ by its pattern to the caregiver as a four-hour spasm medication cycle. Corresponding to line  422 ′ are five additional four-hour interval lines  423 ′,  424 ′,  522 ′,  523 ′  524 ′ positioned in a four, eight, twelve, sixteen, twenty and twenty-four hour spaced apart relationship to line  422 ′, respectively. 
     Second line  425 ′ may be a different color than first line  422 ′ to distinguish between them. Key  432  indicates to a caregiver that line  425 ′ represents a five-hour medication cycle. Corresponding to five-hour line  425 ′ are a second five-hour line  426 ′, a third five-hour line  525 ′ and a fourth five hour line  526 ′ in five hour spaced-apart relationships. 
     Third line  427 ′ may be a different color than lines  422 ′ and  425 ′ to distinguish among them. Once again, key  432  denotes line  427 ′ as a six-hour medication cycle line. Corresponding to third line  427 ′ are three additional six-hour lines  428 ′,  527 ′,  528 ′ which are positioned on spasm wheel  416  in a six-hour spaced-apart relationships. 
     As with the pain wheel  414  above, those of skill in the art will appreciate that depending on the medications being administered to a patient, the four-hour, five-hour and six-hour medication cycles for the spasm wheel  416  may change and, therefore, are illustrative and not limiting. 
     To illustrate the use of the taper wheel  200  we refer again to  FIG. 2  by way of example. Those of skill in the art will appreciate that the taper wheels illustrated in  FIGS. 3 and 4  operate similarly. Arrow  221 ,  221 ′ is always the starting point, no matter what time interval the administration of medication is desired. The arrow may be red or any color that will easy for a user to readily identify. Arrow  221 ,  221 ′ is set or moved to the time the patient starts the daily calculation and is often based on the timing of the previous day. The arrow  221 ,  221 ′ on the pain wheel and/or the spasm wheel is rotated to the desired start time. Assume a pain medication that must be administered every four hours. Therefore, in use an operator first positions arrow  221  at 10:00 a.m. located on base  212  as shown in  FIG. 2 . This position corresponds to the first planned administration of medication for pain. It can be noted that line  223  is now positioned at 2:00 p.m. which is 4 hours from 10:00 a.m. and that line  224  is positioned at 6 p.m. which is four hours from 2:00 p.m. Continuing in this twelve-hour cycle, and without moving the arrow  221  from its original 10:00 am position, the caregiver can see that the final four hour dose in this twelve-hour cycle is line  222  which is now 10:00 pm. The caregiver can then go around the circle again to obtain the next twelve-hour time period, thus creating a schedule for twenty-four hours. The spasm wheel  216  works similarly to the pain wheel  214  and arrow  221 ′ will be positioned at the time the first administration of medication is planned. Thus, line  222 ′ is positioned at the time the first administration of medication is planned. Lines  223 ′ and  224 ′ will automatically be positioned at the time that is 4 hours away from the previous time that the medication is administered with the first line  222 ′ completing the twelve hour time period. A worksheet may accompany the administration of medication to keep track of the appropriate timing of the medication, the patient&#39;s reaction to the medication and the development of any side effects. 
     Assume now that the caregiver wishes to start tapering the pain and spasm medications by increasing the time interval from a four-hour to a five-hour interval. The arrows  221 ,  221 ′ are set to the time the pain and spasm medications will first be administered. Referring to  FIG. 2  assume this time is 10:00 a.m. As can be noted, lines  225 ,  225 ′, the five-hour interval lines, are automatically positioned at 3 p.m., which is five hours from the first administration of medication. Similarly, lines  226 ,  226 ′ automatically lines up to 8:00 p.m., which corresponds to the time that is five hours away from 3:00 p.m. To obtain the next twelve hour cycle, arrow  221 ,  221 ′ is positioned at 8:00 p.m. Lines  225 ,  225 ′ and  226 ,  226 ′ will automatically line up with 1:00 a.m. and 6:00 a.m., respectively. 
     Assume now that the caregiver wishes to again increase the time interval for administering medication to the patient to 6 hour intervals tapering the amount of medication again. Referring generally to  FIG. 2 , by way of example, the starting point is always arrow  221 ,  221 ′. Assume the caregiver positions arrows  221 ,  221 ′ on 10:00 a.m., which corresponds to the first time the medication will be taken. As noted lines  228 ,  228 ′ which represent six-hour interval lines are automatically positioned at 4:00 p.m. Again, without moving arrow  221 ,  221 ′ from the original 10:00 am position, the caregiver can see that the next 6 hour dose is identified by line  227 ,  227 ′ at 10:00 pm., thus completing the twelve-hour cycle. 
     The twenty-four hour taper wheel as best seen in  FIG. 4  works similarly to the taper wheel depicted in  FIG. 2  except that no additional repositioning of arrow  221 ,  221 ′ to the next twelve hour cycle is necessary. 
     Those of skill in the art will appreciate that additional time intervals may be included on the taper wheel in accordance with the invention if a slower withdrawal from medication is desired. 
     Various modifications and additions may be made to the exemplary embodiments disclosed herein without departing from the scope of the invention. For example, while the embodiments disclosed herein refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternative, modifications and variations as fall within the scope of the claims and equivalents thereof.