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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 .