CURRENT CONCEPTS IN PAIN MANAGEMENT

THERAPEUTICS

Dr Rajeev Harshe MD

Consultant pain managementApollo Hospitals, Ahmadabad.

(Hon. Pain consultant to H.E. Governor of Gujarat)

CONTENT TIME (15 MINUTES)

Why pain management ?Current practices in IndiaHow best can be done ?

Acute pain management-brief overviewChronic pain management-brief overview.

WHY PAIN MANAGEMENT ?

Human issue Recovery issue Hypersensitivity issue Legal aspect NABH/JCI issue Economic issue (faster turnover)

PRESENT PRACTICESACUTE PAIN MANAGEMENT

I/M shots periodically I/V shots periodically Rectal suppositories I/V infusions ( 5% centers) Random use of patches

LACUNAE(ACUTE PAIN MANAGEMENT)

Possibility of Inadequate analgesia Lack of dedicated person to look after pain

relief Patients even if suffer.. feel it is a part of

experience.

HOW IT SHOULD BE ?(ACUTE PAIN MANAGEMENT)

Multimodal analgesia Infusion better Bolus for breakthrough pain more

gratifying Topical and regional analgesia better

used Pain Team including pain nurse. Consider status of liver/kidney/brain

CURRENT MODALITIES

Portable infusion pump ( Elastomeric) PCA PCEA Diclofenac/ketorolac/buprenorphine

patches Lollypops / Lozenzes Nasal sprays

COMMONLY USED MEDICINES

NSAIDS Opioids: Morphine,

Fentanyl,buprenorphine,Tramadol Other: Paracetamol IV 1 gm qds Dexmedetomidine Clonidine/ketamine/neostigmine

NEWER INTERESTS

Tapentadol (dual action) Methadone (prolonged single shot

preop.) Oxycodone Opioid antagonists Gabapentine in acute pain ( neuropathy) Opiorphine ( prevents degradation of

endogenous Opioids) ibudilast

CHRONIC PAINCURRENT CONCEPTS IN

MANAGEMENT

Diagnostic cum therapeutic nerve blocks- (somatic and sympathetic) Radiofrequency ablation of sensory nerves Epidural/ intrathecal infusions by implantable

pumps Peripheral plexus infusions by portable pumps Percutaneous epiduroscopy and adhesiolysis Spinal stimulation by implanted stimulators Various disc procedures for IDDs

CHRONIC PAIN SYNDROMES ADDRESSED

Pain due to spondylitis Pain due to propalsed disc Listhesis induced pain Vertebral pain Myofascial pain Neuralgias –trigeminal / post herpetic Malignancy pain Pain of vascular origin Persistent pain after spine surgery

MODALITIES ON HORIZON

Platelet rich plasma injections. Stem cell treatment Nasal sprays for any kind of pain

FUTURE HOPE ????

Can we have Aroma Therapy used for analgesia?

THANKS

Dr Rajeev Harshe MD

Consultant pain managementApollo Hospitals, Ahmadabad.

(Hon. Pain consultant to H.E. Governor of Gujarat)