Pain management

description about pain management

1. PAIN MANAGEMENT BY, NADIRA SULTANA PHARM.D (INTERN) MTRIPS HKE’S GULBRGA

2. Pain Defination : Pain is an unpleasant sensory and emotional experience associated with actual and potential tissue damage

3. Important implication Pain is physical and emotional experience, not all in the body or all in the mind It is in response to actual or potential tissue damage, so there may not be abnormal lab or radiographic reports despite real pain

4. Signs and symptoms of pain Increased heart rate Increased respiratory rate Peripheral vasoconstruction Pallor Elevated BP Increased blood glucose level Diaphoresis Dilated pupils

5. Types of pain

6. Based on duration Acute Chronic C hronic non cancer pain Chronic cancer pain Chronic episodic pain

7. Acute pain When pain lasts only through the expected recovery period. Acute pain is protective, has an identifiable cause, is of short duration and has limited tissue damage and emotional response. It eventually resolves with or without treatment ,after an injury area heals

8. Complete pain relief may not be achievable, but reducing pain to a tolerable level is realistic. Unrelieved acute pain can progress to Chronic pain.

9. Chronic pain Is the pain that lasts longer than 6 months and is constant or recurring with mild to severe intensity . It does not always have an identifiable cause. Eg : arithritic pain, headache, peripheral neuropathy.

10. The possible unknown cause of chronic pain, combined with unrelenting nature and uncertainty of its duration , frustrates a patient, frequently leading to psychological depression. Associated symptoms of chronic pain: fatigue, insomnia, anorexia, wieght loss, hopelessness, anger.

11. Chronic non cancer pain That results due to non cancer disease condition.

12. Chronic cancer pain Is the pain caused by tumour progression and related pathological process, involves procedures, toxicities of treatment, infection and physical limitations.

13. Chronic episodic pain Pain that occurs sporadically over an extended period of time. Pain episodes last for hours, days or weeks eg : migraine headaches

14. BASED ON LOCATION This is based on the site at which the pain is located eg : headache, cardiac pin, back pain, joint pain, stomach pain, Reffered pain- pain due to problems in other areas manifest in different body parts. Eg : cardiac pain may be felt in the shoulders or left arm, with or without chest pain

15. BASED ON INTENSITY Mild pain Moderate pain Severe pain

16. Pain measurement scale

17. Based on intensity Mild pain: pain scale reading form 1-3 is considered as mild pain Moderate pain: pain scale reading form 4 - 6 is considered as moderate pain Severe pain: pain scale reading from 7 – 10 is considered as severe pain

18. BASED ON ETIOLOGY

19. NOCICEPTIVE PAIN Is experienced when an intact, properly functioning nervous system send signals that tissue are damaged requiring attention and proper care. Eg : the pain experienced following a cut or broken bone alerts the person to avoid further damage until it is properly healed. Once stabilised or healed the pain goes away

20. Somatic pain This is the pain that is originally from the skin , muscles, bone, or connective tissues. eg : the sharp sensation of a paper cut or aching of a sprained ankle

21. Visceral pain Is the pain that results from the activation of nociceptors of the thoracic , pelvic, or abnormal viscera (organs) Characterised by cramping, throbbing, pressing or aching qualities. Eg : labor pain, angina pectoris pr irritable bowel

22. Neuropathic pain Neuropathic pain is associated with damage or malfunctioing nerve due to illness, injury or undertermined reason. Examples Diabetic peripheral neuropathy phantom limb pain Spinal cord injury pain

23. It is usually chronic. It is describe as burning, “electric shock”, and/or tingling, dull and aching. Neuropathic pan to be difficult to treat.

24. There are 2 types of neuropathic pain and classified as follows Peripheral neuropathic pain: Due to damage of peripheral system eg : phantom limb pain Central neuropathic pain: Results from malfunctiong nerves in the CNS eg : spinal cord injury pain post stroke pain

25. Pain assessment P recipatating / allveiating factors what causes the pain? What aggravetes it? Has medication or treatment worked in the past? Q uality of pain Ask the patient to describe the pain using words like....sharp, dull, stabbing, burning R adiation Does pain exist in one location or radiate to other areas? S everity Have patient use a descriptive ,numeric or visual scale to rate the severity of pain? T iming Is the pain constant or intermittent, when did it begin?

26. Assess the objective signs of pain Facial expression: facial grimacing, frowning Vocalization: crying, moaning Body movements: guarding resistance to moving

27. Grimacing face

28. Frowning face

29. Crying and moaning

30. Pain assessment tools There are various tools that are designed to assess the level of pain Verbal rating scale Numeric rating scale Wong Bakers faces rating scale

31. Management of pain Pain can be managed through Pharmacological interventions Non pharmacological interventions

32. Pharmacological intervations Mild pain paracetamol or NSAIDS such as ibuprofen or aspirin can be priscribed NSAIDS have an antiinflammatory analgesic and antipyretic effects The antiinflammatory action relieves pain by interfering with cyclooxygenase

33. Mild to moderate pain Paracetamol or NSAIDS and/or PCT in combination product with weak opoid such as hydrocodine , may provide greater relief than their separate use.

34. Moderate to severe pain when treating moderate to severe pain ,the type of pain , acute or chronic ,needs to be considered The type of pin can result in different medication being prescribed. Certain medication may work better for acute pain ,other for chronic pain and some may work equally on both.

35. NSAIDS NSAIDS produce the effects through cyclooxygenase inhibition and are widely used to relieve pain, with or without inflammation in people with acute and chronic pain.. In single dose NSAIDS have analgesic activity In regular higher dosage they have both long acting analgesic and an antiinflammatory action effects, which makes them particularly useful for the treatment of continous or regular associated with inflammation

36. Salisylate →aspirin→325-600mgevery 4 th houlry Para aminophenol → acetominophen → 325-650mg (3-4 times a day) Fenamates → mefanamic acid → 250-500mg TDS Propionic acid → ibuprofen=400-800mg TDS naproxen=250mg TDS ketoprofen =50-100mg BD-TDS flurbiprofen =50mg BD-QID 5. Diclofenac =50mg TDS, then BD oral, 75mg deep i.m

37. Opioids analgesic Opiods bind to one of the four opiate receptors: mu, kappa, sigma, delta Opiod can provide short intermedite or long acting analgesia depending upon the specific properties of the medication . Opiods may administer through IV, oral, nasal mucosa, oral mucosa, rectal, transdermally

38. Adjuvants Used for analgesic reason and for sedation and reducing anxiety Examples tri cyclic antidrepresants antiepileptic corticosteriods

39. Non pharmacological management For many individuals, use of non pharmacologic methods enhance pain reliefs These non pharmacological strategies are often used combination with medication

40. No pharmacological therapies Heat and cold application Medication Distraction Imaginary TENS application Yoga Massage Accupunture Music therapy Herbal therapy-garlic, echinesea , ginseng