Download - Pain Management.docx

8/16/2019 Pain Management.docx

1/8

PAIN MANAGEMENT

A branch of medicine employing an interdisciplinary approach foreasing the su ering and improving the life of those in pain(Wikipedia, 2014 !

Pain:

"e#ned as an unpleasant sensory and emotional e$perienceassociated %ith actual or potential tissue damage or described interms of such damage!

Modulation Pain:"i erent individuals have variability in pain felt even in in&uries ofsimilar magnitude!

'uggestions that a treatment %ill relieve pain can have asigni#cant analysis e ect (placebo e ect suggests that pain %ill%orsen follo%ing administration of an insert substance canincrease its perceive intensity (nocebo e ect !

Pain Classifcation:

eferred pain spatial displacement of pain sensation from the siteof in&uries that produces it!

Neuropathic Pain:

)esions of the peripheral or central nociceptive path%ay typicallyresult in lose or impairment of pain sensation and can alsoproduce pain!

* 'evere and resistant to standard treatment for pain!* +sually burning, tingling, pulsating or of electric shock*like

uality!* -ay be triggered by very light touch !.ains by %hich can be

called neuropathic!

1


2/8

* "amage s to peripheral nerves e!g! diabeticneuropathy,continued pain continued e$perienced from alimb %hich has been amputated!

* "amages to primary a erents e!g! herps /oster!

* "amages to ' e!g! erebrovascular in&uries to spinal cord,brain stem!

Sympathetically maintained pain :

'pontaneous pain that occur in patients %ith peripheral nervein&ury!

* egins after a delay of hours to days or even %eeks!* Accompanied by s%elling of the e$tremilies periarticular

bone loss and arthritic changes!* .') (re3e$ sympathetic dystrophy occurs %ithout obvious

nerve in&ury and resolves %ith symptomatic treatment! 'ignsand symptoms suggest over activity of the sympathetic

.' (.ost traumatic neuralgia or if severe (causalgia !

5ccurs %ith an identi#able nerve in&ury!

Nocieptive Pain:

* .ains associated %ith sprain ankle!* cro%ding other body parts near the cancer site!* .ains in diseases such as arthritis* "unded in to t%o types radicular or sematic!

Goals of pains management

6o remove all the pain (if possible !

6o remove the cause of the pain!

6o minimi/e side e ects of pain reliever!

6o cause the patients %ould once more be able to carry outactivities that %as hindered by the pain!

Pain Management Team:

2


3/8

*.harmacists

* -edical practitioners!* linical psychologists!* .hysiotherapists!* 5ccupational therapists!* linical nurse specialists!

Approaches for treatment (management

1. Non pharmacological.A! .hysical approach7

68 ' (6ranscutaneous electrical nerve stimulation

Acupuncture)ight therapy!

! .sychological Approach7* ognitive behavioral therapy (relationship bet%een one9s

physiology and pain! 6his involves life style changes!* :ypnosis* -indful meditation!

2. Pharmacological approach

Acute pain :

* Co 2 inhi!itor: Aspirin, Acetaminophen, 'A"'!

* nhibit cycloo$ygenase!

* :ave anti*in3ammatory action (e$pect acetaminophen !

* 8 ective for mild to moderate headache!

* +sually available %ithout prescription!

Side e ects:

;


4/8

* o$2 selective e!g! eleco$ib has les gastric irritation butincreases cardiovascular risk contraindicated in patients inthe immediate diet period after coronary bypass!

* Acetaminophen (paracetamol in a high does is to$ic to the

live!* Aspirin has high < 6 irritability and also causes < 6 bleeding!

'A "' have nepheroto$icity and can also increase bloodpressure!

=etorolac is a parenteral form of 'A "s!

*"poi# analgesics:

* -ost potent pain relieving drugs currently available!* "o not usually provide complete analgesia %eather pain is acuteor chromic in origin!

* "rugs tolerance, chemical dependency, diversion and addictionmay occur!

'ide e ects include vomiting pruritus, constipation %ithrespiratory depression (uncommon !

ormeperidene a metabolite of meperidire produes hypere$citability and sei/ures that are not reversible %ith anti opoids!

8$amples includes o$ycoddore, hydromorphore, methadonebicarbonate, penta/ocine pethidine (meperdine ormeperdine isa metabolite of mependine produces hyper e$citability andsei/ures that are not reversible %ith anti opiods!

* 5piods can be given intrathecally eg! (o*o!; mg morphine(used in cancer paheab intravenorslly (8!g! >*10mgmorphine reactively transdermally (fentanyl

* 2nd and ; rd line in pain management!

.atients controlled Analgesia (. A * e%?

4


5/8

* A microprocessor controlled infusion device that can delivera baseline continues dose of opiod doing as %ell aspreprogrammed additional doses %hen the patient pushes abutton!

* 6o prevent overdosing, . A are programmed %ith a lack outperiod of one hour!

* +sed for post*operative pain!* 'hould be used for short*term home care of patients %ith

intractable pain such as metastatic cancer!

@ ote it is important to assess the patients for the risk ofsubstance abuse, misuse or addition before during areadministered!

Chronic Pain:

6his is caused by

* $isease e!g! Arthritis, ancer, hronic daily headaches,#bromyalgia, diabetic neuropathy etc!

* 'econdary, perpetuating factors initiated by diseases andpresent after that disease has resolved e!g! damage sensorynerves, sympathetic e erent activities, and painful re3u$muscle contraction!

* .sychological ondition

"rugs used include7

Anti*depressant medications

6 A' e!g! norhyptytine and desiproamine

Although the mechanism is unkno%n, analgesic e ects of 6 Ashas a more rapid onset and occurs at a lo%er dose than intypically re uired for the treatment of depression!

* 'elective serotonin reuptake inhibitors ('' s e!g!luo$etine (.ro/ac ! 6hese groups have fe%er and less

serious side e ects than 6 As!

>


6/8

* on tricyclic antidepressants!* locks both serotonin and norepinephrine reuptake!* Appears to retain most of the pain reliving e ects of 6 As!* 'ide e ect pro#le more like that of '' 9s!

* .articularly useful in patients %ho cannot tolerate the e ectsof 6 A,s* 6he #rst drug of choice in chronic pain management!

2. Anticonvulsants:

* or neuropathic pains mainly!

* .henytoin ("ilartin and carbama/epine (6egretol 1 st used

* e%er drugs e!g!


7/8

* .enta/ocine and butorphenol have mi$ed against Fantagonist properties!

@5pioids and 6 As!

* 6 As potentiate opioid analgesics and are additive also intheir side e ects!

@ imetidine, 0 en/ymes in the liver!

$r%g&'er! interactions:

'A "s e!g! Aspirin, interact %ith ginkgo, garlic, ginger, bulberry,

dong ual, feverfe%, ginseng, tumeric, meado% s%eet!

paracetamol D ginko *increased bleeding!

.aracetamol D 8chinacea and Gor kava s * increasedhepatoto$icity!

.aracetamol D herbs contarnury selicyelate glues an increase innephroto$icity!

5pioid analgesic D valerein, kava and chamomille cause anincrease central nervous system depression!

5pioid analgesic D #nseryHHH nhabits e ect!

easons for de!ciencies in patient pain management:

* .hysicians usually prescribe inade uate dose of opioids inmanaging severe pain for fear of being accused of over

prescribing !* -isconception that pain is a normal peart of eging !* nade uate training!* .ersonal bias!* .oor assessment!

Note that

I


8/8

ntrathecal drug delivery system for severe and persistentpain!8pidural in&ection of glucocorticoids!

"#N"$%SN

.sychological pain is all around us (emotional, physical, etcbut if measures are taken to assess properly the aspect ofpain that is most central in the life of any individual, usuallyalmost all other pains are taken care of!

'(' 'N"'S%%%!medtronicneuro!con! AuGchronic pain*common type Bhtml!%%%! po%er over your pain!comGunderstandGchronic Gpaintypes!%%%! -edicienent! omG pain*management Gpage 2!html%%%!help for pain !comGarticles G understand*neurpathin*painG understanding!html!

%%%!%ebmd! omGpain*managementGfuide Gpain*management*symptoms*types!%%%!annies remedy !comGchartGphp!=umar and chart (2002 clinical medicine! 8dition! %!bsunder!)ongo etal (2012 !:arrison9s principles of internal medicine 1J th edition!http7 llen! Wikipedia!orgG%ikiG pain management!

J
http://www.power/http://www.power/