Download - Pain relief in sickle cell disese
![Page 1: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/1.jpg)
Pain relief; A basic human right
Yousf M. Tak Consultant of Anesthesia
Security Forces Hospital Dammam KSA
![Page 2: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/2.jpg)
Regards from Kashmir; a paradise on earth
![Page 3: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/3.jpg)
Pain relief; A basic human right
Pain is leading cause of ER visits and hospitalizations
Pain is a common mode of presentation in patients with sickle cell disease (SCD) but there is considerable variability in the way SCD pain is managed
![Page 4: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/4.jpg)
Pain relief; A basic human right
Pain is common undertreated entity
One of the factors contributing to poor pain management is
conflicting perceptions between patients, their families and
healthcare professionals about pain that is reported and
analgesia that is required (Stinson & Naser, 2003).
![Page 5: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/5.jpg)
![Page 6: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/6.jpg)
Pain relief; A basic human right
The most reliable indicator of the existence pain and its intensity is the patient’s description
![Page 7: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/7.jpg)
Pain relief; A basic human right
The aim of the wise is not to secure pleasure, but to avoid pain. Aristotle
Pain is a worst lord of mankind than death itself.
![Page 8: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/8.jpg)
Pain relief; A basic human right
.
Tachycardia And elevated blood pressure
Decreased Limb movement; increased risk of DVT
Respiratory effects; shallow breathing , tachypnea, cough suppression
due to increased risk of pneumonia & atelectasis
Decreased GI Motility
Increased catabolic demands
![Page 9: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/9.jpg)
Pain relief; A basic human right
Psychological effects of Pain
Negative emotions: anxiety, depression
Sleep deprivation
Existential suffering: may lead to patients seeking active end of life
Immunologic Effects of pain Decrease natural killer cell counts Effects on other lymphocytes not yet defined
![Page 10: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/10.jpg)
Pain relief; A basic human right
5TH Vital Sign
Basic human Right; Human rights watch
![Page 11: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/11.jpg)
Pain relief; A basic human right
Effective control of pain
Lack of awareness among public
Minimal knowledge among health providers
![Page 12: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/12.jpg)
Pain relief; A basic human right
Pain Clinic
![Page 13: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/13.jpg)
Pain
Step 1Nonopioid
Adjuvant
Pain persisting or increasing
Step 2Opioid for mild to moderate pain
Nonopioid Adjuvant
Pain persisting or increasing
Pain persisting or increasing
Step 3Opioid for moderate to severe pain
Nonopioid Adjuvant
Invasive treatments
Opioid Delivery
Quality of Life
Modified WHO Analgesic Ladder
Proposed 4th Step
The WHO
Ladder
Deer, et al., 1999
![Page 14: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/14.jpg)
Pain relief; A basic human right
![Page 15: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/15.jpg)
Pain relief; A basic human right
![Page 16: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/16.jpg)
Pain relief; A basic human right
![Page 17: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/17.jpg)
Pain relief; A basic human right
Pain relief; A basic human right
![Page 18: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/18.jpg)
Pain relief; A basic human right
Paediatric Scales
![Page 19: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/19.jpg)
Pain relief; A basic human right
0
Mafee alam No Pain
1
Shoa alam Mild Pain
2
Nus nus alam Moderate pain
3
Kateer alam) Severe Pain
Table: Severity of pain (Using a simple pain score).
![Page 20: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/20.jpg)
Acute Pain in Sickle Cell Disease
Somatic pain
– Deep structures
– Focal or referred
Visceral pain
– Spleen, liver, lungs
– Vague, poorly localized, referred, diffuse, dull-aching in character
– Nausea, vomiting, sweating
– Associated with muscle spasms, tenderness, hyperaesthesia
![Page 21: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/21.jpg)
Comprehensive Regimen for the sickle cell disease pain
Maintenance therapy with opioid analgesic
Non opioid analgesic
Rescue therapy for breakthrough pain
Adjuvant therapy
Anxiolytics/muscle relaxants
Laxatives
Non-pharmacologic therapy
Incentive spirometry
Hydration (1-1.5x maintenance)
Physical: Heating pads, massage, TENS, acupuncture, physical therapy
Behavioral: Relaxation, deep breathing, behavior modification, biofeedback
•Psychological: cognitive therapies, distraction, social support, hypnotherapy
![Page 22: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/22.jpg)
Pain relief; A basic human right
WHO Pain Ladder
![Page 23: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/23.jpg)
Meperidine
Shorter duration of action (1-2 hours only )
Seizures on repeated administration
Dermal and sub dermal fibrosis on I.M injection
Pethidine
Narrow therapeutic index
Norpethidine > Antagonistic
Seizures on repeated administration
![Page 24: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/24.jpg)
Pain relief; A basic human right
![Page 25: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/25.jpg)
Pain relief; A basic human rightS.No Severity of pain Regimen
1 Mild Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
2 Moderate Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
+
Tramadol50-100mgs Q 8H
3 Severe Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
+
Morphine 5-mgs Q 8 H
![Page 26: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/26.jpg)
Pain relief; A basic human right
PRN Schedule Illogical
Pain Cycle (Basal + Incident + Breakthrough Pain
Start (1Hr)} Asses} Reassess} Adjust
Tapering and not abrupt withdrawl
![Page 27: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/27.jpg)
Pain relief; A basic human right
NSAIDS
Bone Pain
Opiod Sparing
Ceiling Effect
Opiods
Potent analgesics
Safety Profile
![Page 28: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/28.jpg)
Pain relief; A basic human right
Addiction
Nightmare for physician
Curse for the patient
![Page 29: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/29.jpg)
Pain relief; A basic human right
When asked, 59% of the patients desired that oral non-opioid analgesics be prescribed while 31% were not bothered about what analgesic was given. Only 8% requested opioids.
A total of 65% of the patients did not require hospital admission but were observed in the day-care unit and allowed home within 24 h. Only 17% required hospital admission for more than a week.
![Page 30: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/30.jpg)
Pain relief; A basic human right
Prevention of Pain
Triggers of pain: viral illness,
infection/sepsis, stress, extreme exercise,
change in temperature, change in altitude
Fluids (2 glasses of water q 2 hours)
Avoiding extreme temperatures, activities (e.g. swimming in cold
water)
Regular moderate exercise
Penicillin prophylaxis to prevent infection
![Page 31: Pain relief in sickle cell disese](https://reader034.vdocument.in/reader034/viewer/2022052622/559438aa1a28ab367c8b45e3/html5/thumbnails/31.jpg)
STAY PAINFREE