PRANESH KUMARM.PHARM (Double Goldmedalist)

Ph.D. (P)BBAU Central University, LUCKNOW

CLINICAL MANAGEMENT OF PAIN

Table of content:

INTRODUCTION

TYPES OF PAIN

PATHWAY OF PAIN

MANAGEMENT OF PAIN

REFERENCES

Introduction:

PAINPain can be defined as an unpleasant sensory and emotional experience that is associated with

actual or potential tissue damage.

Accurate assessment of pain is necessary if pain management is to be effective. Patients with pain are often undertreated.

Types of Pain:

Types of Pain

Acute Pain Chronic Pain

Malignanted chronic Pain Non malignanted chronic Pain

Acute pain:

Acute pain is of short duration and lasts less than 3 to 6 months. Intensity of acute pain is from mild to severe.

Causes of acute pain include postoperative pain, procedural pain, and traumatic pain. Acute pain usually sub-sides when the injury heals.

Chronic Pain:

Malignanted chronic pain:Chronic pain associated with malignancy includes the

pain of cancer, acquired immunodeficiency syndrome (AIDS), multiple sclerosis, sickle cell disease, and end-stage organ system failure.

Non malignanted chronic pain:The exact cause of this pain is unknown but it is

associated with various musculoskeletal disorder rheumatoid arthritis, and osteoarthritis ect

Pathway of pain:

Management of pain:

Types

Pharmacological Interventional

Pharmacological management:

Classification

Local Anaesthetics Opioids Salicylates Non

salicylates

Local anaesthetics:

Lidoderm: 5% Lidocaine Patch Each Patch Contains 700 mg of Lidocaine Should be Applied to Intact Skin About 3% is Absorbed 1-3 Patches Once a Day for 12 hrs

Opioids:

Bind to Opioid Receptors: Mu, Delta and Kappa

Morphine, Hydromorphone, Meperidine, Fentanyl, Codeine, Methadone, Oxycodone, Hydrocodone, Tramodol

Opioids may be Combined with NSAIDs to Enhance the Opioid Analgesic Effect

Opioids drugs:

Drugs IV Dose (mg) Oral Dose (mg)

Morphine 10 15-30

Hydromorphine 1.5 4-8

Methadone 10 5-10

Codeine 8 5-10

Oxycodone 5-10 15-30

Hydrocodone 5-10 15-30

Patient Controlled Analgesia:

Small Doses of Analgesic Drug (Usually Opioids), are Administered (IV) by Patient.

Allows Basal Infusion and Demand Boluses Over Dosage is Avoided by Limiting the Amount and Number of Boluses in a Set Period of Time

Salicylates:

The salicylates include aspirin (acetylsalicylic acid) and related drugs, such as magnesium salicylate and sodium salicylate. The salicylates have analgesic (relieves pain), antipyretic(reduces elevated body tem-perature), and anti-inflammatory effects.

Eg . Aspirin Buffered aspirin Magnesium salicylates Sodium salicylates

Non salicylates:

The major drug classified as a non salicylate is acetaminophen (Tylenol, Datril, Panadol). Acetaminophen is the only drug of its kind available in the United States at this time. It is the most widely used aspirin substitute for patients who are allergic to aspirin or who experience extreme gastric upset when taking aspirin.

Interventional:

Types

Epidural Anaesthesia

Spinal Anaesthesia

Epidural anaesthesia:

Spinal anaesthesia:

Pain Assessment Tools:

Reference:

Acute Pain Management Guideline Panel. Acute pain management: Operative or Medical Procedures and Trauma Clinical Practice Guideline. AHCPR Publication No. 92-0032.

Rockville, MD. Agency for Health Care Policy and Research, US

Department of Health and Human Services, Public Health Service, 1992.

Backonja M, Beydoun, A, Edwards KR, et al. Gabapentin for symptomatic treatment of painful neuropthy in patients with diabetes mellitus. JAMA 1998;280:1831-1836.

Tripathi KD ,Essentials of Medical Pharmacology 6 th edition jaypee brothers medical publisher pg no.167-184 .