acute pain management jpmc

8/12/2019 Acute Pain Management Jpmc

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Acute Pain Management


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Pain

Pain is an unpleasant feeling that is

conveyed to the brain by sensory

neurons as a result of injury, disease or

emotional disorder


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Pain

Acute pain

Less than six months duration

Cause is usually known

Disappears when the injury heals

Chronic pain

More than six months durations

Persists after injury heals

Cause may or may not be known

IASP website, 2007


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Types of pain

Neuropathic (burning, tingling, pins and

needles sensation)

Psychogenic

Idiopathic


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Common types of acute pain

Type or source Definition Examples

Acute illness Pain associated with an

acute illness

Appendicitis, renal colic,

myocardial infarction

Prioperative (includes

postoperative)

Pain in a surgical

patient because of pre-

existing disease,

surgical procedure,

associated drains, chest

or NG tube

Head or neck surgery,

chest and chest wall,

abdominal, orthopedic

surgery

Post traumatic (major

trauma)

Generalised or

regionalised pain due to

major acute injury

Motor vehicle accident


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Common types of acute pain

Type or source Definition Example

Post traumatic (minor

injury)

Pain due to minor injury Sprain, laceration

Burns Pains due to thermal or

chemical burns

Fire, chemical exposure

Procedural Pain associated with a

diagnostic or

therapeutic medical

procedure

Bone marrow biopsy,

endoscopy, suturing

catheter and chest tube

placement,circumcision,

immunizationObstetrical Pain related to labour

and delivery

Child birth by vaginal

delivery or cesarean

section


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Pain pathways

Tissue injury activate nociceptors pain

impulse A-delta & C fibers dorsal horn

spinothalamic tract thalamus

cerebral cortex cerebellum

Mediators

Prostaglandin, bradykinin, substance P,

serotanin, histamine


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Physiological effects of pain

Endocrine effects

Increased catabolichormones (glucagon, GH,vasopressin )

Decreased anabolichormones (insulin,

testosterone)

Haematologic effects

Increased plateletadhesiveness

hyper coagulability

Immune effects

Lymphopaenia

Leukocytosis

Musculo skeletal

muscle spasm, immobility,

increased risk of DVT

muscle wasting, prolonged

recovery

CNS

central sensitization,

chronic pain

Psychological

Anxiety, fear, sleep

deprivation, increased pain

Urinary effects

Urinary retention


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Non pharmacological

Transcutaneous nerve stimulation

Cognitive and behavioral therapy

Heat and cold

Physical and occupation therapy Rehabilitation

Progressive muscle relaxation

Psychotherapy

Massage, accupuncture and accupressure Exercise therapy

Lifestyle changes


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Multimodal analgesia

Drugs

Reduce doses of each analgesic

Synergistic / additive effects

Decrease severity of side effects of each

drug

Technique

Oral, I/M, I/V, S/C, per rectal, nerve block,

plexus block, epidural block


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Treatment

Pharmacologic

Opioid

Non opioid

Adjuvant


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Pain management guideline

Pain symptom

intensity

Drug selection

Constant moderate tosevere pain

Intermittent pain

Long acting analgesics +prnshort acting analgesics

prn short actinganalgesics

Mild

Moderate

severe


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Multimodal analgesia


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Non opioids

Acetaminophen

Local anesthetic drugs

Nonsteroidal anti-inflammatory drugs

steroids

No physical dependence

No tolerance


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Acetaminophen

Effective analgesic

Action

Analgesic

Antipyretic

Anti-inflammatory agent

Relative safety

Effective for the musculoskeletal aches,

joint stiffness


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Acetaminophen

Disadvantage

Dose-dependent hepatotoxicity, GI upset

Agranulocytosis

Dosage

650-1000 mg PO q 4 hr.

Max. 4 g/d

Reduce dose 50-70%in patient with

significant hepatic impairment


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NSAID

Drug Dosage Maximum daily

dose

Nonselective

inhibitor

Diclofenac

Indomethacin

Ibuprofen

50 mg PO bid-tid

75 mg PO bid

200-800 mg q 6

hr.

200 mg

150 mg

3200 mg

Cox-2 inhibitor

Celecoxib 100-200 mg PO

bid

400 mg


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Thank you

acute pain management jpmc

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