there are three kinds of people, the scholars, the seekers of knowledge and
DESCRIPTION
There are three kinds of people, the scholars, the seekers of knowledge and all the others are a waste of humanity. Jafar AlSadiq. CHRONIC PAIN SYNDROME. - PowerPoint PPT PresentationTRANSCRIPT
There are three kinds of people,
the scholars,
the seekers of knowledge
and
all the others are a waste of humanity.
Jafar AlSadiq
Dr. Nasir Imran ZaidiConsultant Anaesthetist, Railway General Hospital
Assistant Professor, Islamic International Medical College
Rawalpindi
This presentation and its relevant material can be obtained by sending an email to [email protected]
Available to all those who take part in propagation of the knowledge
Chronic Pain Chronic Pain
Chronic Pain define as:
Pain persists beyond either the course of an
acute disease or reasonable time for an injury to
heal
Pain is associated with chronic pathological
process
Pain that recurs at interval of months or year
Chronic Pain SyndromeChronic Pain Syndrome
I Malignant
Cancer pain syndrome
II Non-Malignant
Nociceptive
Neuropathic
Psychogenic
Nociceptive Low back pain Myofacial pain Visceral pain Headache and facial pain Neck and shoulder pain
Neuropathic pain Sympathetically mediated pain Post herpetic neuralgia Trigeminal neuralgia Phantom pain
Modalities of Pain Management Modalities of Pain Management
I Pharmacological
II Anaesthesiologic
III Special technique
* Facet Blocks
* Acupuncture (Gate control theory)
* Cryolysis
* Ablative technique
* Radio frequency
* Physical therapy
PharmacologicalPharmacological
Analgesic
Paracetamol
NSAID Opioids
Co-analgesics
Anti-depressant Anti-convulsant
Contd...
Anesthisiologic Central nerve blocks
○ Spinal ○ Epidural
Peripheral nerve blocks ○ Femoral ○ ICN ○ Others
Autonomic Nerve blocks○ Stellete ganglion ○ Lumber Sympathectomy
Contd...
Special Technique Special Technique Facet block for back pain
Cryolysis for nerve damage
Radio frequency for facet joint / nerve damage
Acupuncture 361 classical acupuncture points lie along specific
pathway or meridians
Ablative neuro-surgical procedure - interrupt
sensory pathways to the brain or in the brain
and brain stem.
Contd...
Low Back PainLow Back Pain
Most common condition seen in the pain clinic
Major causes: Prolapse inter-vertebral disc Facet joint degeneration Sacroiliac joint arthritis Musculoskeletal disorder Miscellaneous
Prolapsed Intervertebral Disk
Management of Low Management of Low Back PainBack Pain
Do not miss a treatable cause of pain in
the rush to treat the symptoms
Pain alone may not justify
decompression surgery like
laminectomy or micro-discectomy
Treatment OptionsTreatment Options
Drug therapy vs nerve block procedure drug therapy NSAID, week opioids & other
support therapyLow morbidity out patient
○ Epidural steroid
○ Facet joint steroid injection
○ Sacroiliac steroid injection
As a first line of treatment
Myofacial Pain Syndrome Pathogenesis
The likely has a central mechanism, with peripheral clinical manifestations.
CausesAbnormal stresses on the muscles from sudden stress on
shortened muscles, leg-length discrepancies, or skeletal asymmetry
Poor posture, static position for a prolonged period of time Chronic infections and sleep deprivation
Anemia and low levels of calcium, potassium, iron, and vitamins C, B-1, B-6, and B-12 are believed to play a role
radiculopathy, visceral diseases, depression, Hypothyroidism, hyperuricemia, and hypoglycemia
Complex Regional Pain Syndrome : CRPS
Recently the sub-committee on taxonomy of IASP has
replaced the terms RSD and Causalgia to Chronic
regional pain syndrome (CRPS)
RSD - CRPS I
Causalgia - CRPS II
Sympathetically Mediated Pain (SMP)
Reflex sympathetic dystrophy (RSD) and causalgia
RSD
A group of condition associated with extremity pain and
autonomic dysfunction
Causalgia
Specific syndrome of burning pain and autonomic
dysfunction associated with major nerve trunk injury.
SMP / SIP
SMP (sympathetically mediated pain) SIP (sympathetically independent pain)
Majority of CRPS are associated with SMP but fewer cases are found to be SIP.
Treatment Options of CRPSTreatment Options of CRPS Drug therapyDrug therapy
Antidepressant Anti convulsant Narcotic analgesic Oral nifedipine Adrenergic blocking agents
Nerve BlockNerve Block Chemical sympathectomy Intravenous regional block (Bier’s Block)
Physical therapyPhysical therapy Tens therapy
Post-herpetic Post-herpetic neuralgia neuralgia Pain in the distribution of a nerve It follows an acute herpetic attack (shingles)
Incidence: 3-4 per 1000
Clinically: Burning pain constant deepache crawling or scratching pain stabbing or shooting
ManagementManagement
Drug therapy (main stay)
Anticovulsant
Anti depressant
Nerve block
Little role
Trigeminal NeuralgiaTrigeminal Neuralgia
Conditions occur more often in Female middle aged
Strictly unilateral, however in 2% it may be bilateral
Pain in the face is characterized by sharp, severe (paroxysmal) and brief lasting no more then a few seconds.
Management of Trigeminal Management of Trigeminal
Neuralgia Neuralgia
Drug Therapy
Anti-convulsant
Anti depressant
Nerve block
Cryo-analgesia
Radio-frequency
Malignant Pain Malignant Pain SyndromeSyndrome
Incidence
70% of cancer patients suffer
from pain as a symptoms
Management Strategies Pharmacological methods
Interventional pain management
neurolytic blocks
Intraspinal drug delivery system
Others
physical therapy
Tens therapy
Pharmacologic therapy Pharmacologic therapy
“Analgesic staircase”“Analgesic staircase”
Strong opioids +/- adjuvant
Weak opioids +/- adjuvant
Non-opioids NSAID +/- adjuvant
Invasive ProceduresInvasive Procedures When pain or side effects persist despite
comprehensive trials of pharmacologic therapy
I Neurolytic blocks
○ Coeliac plexus
○ Hypogastric plexus
II Intra-spinal drug delivery
○ short terms – intrathecal or epidural infusion
○ long term – implants
CONCLUSIONCONCLUSION
Control of pain in chronic pain syndrome can be
achieved in most patients by the application of a
carefully individualized, flexible programme of :
analgesic drugs
Interventional pain management
Certainly, knowledge is a lock and its key is the
question
Quote by: Ja'far al-Sadiqas
The teacher of Jabir ibn Hayyan,
an astronomer, alchemist, Islamic scholar, Islamic theologian, writer,
philosopher, physician, physicist and scientist.