pain - definition ‘ an unpleasant sensory and emotional experience associated with actual or...

PAIN - DEFINITION ‘AN UNPLEASANT SENSORY AND

EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE’

Ref: International Association for Study of Pain

CLASSIFICATION OF PAIN ACUTE

CHRONIC

NOCICEPTIVE

NEUROPATHIC

PSYCHOGENIC

MEASUREMENT OF PAIN

VISUAL ANALOGUE SCALE (VAS) VERBAL RATING SCALE McGILL PAIN QUESTIONNAIRE PAKISTAN COIN SCALE (PCS)

Pain Assessment Scales

No Mild Moderate Severe Very Worstpain pain pain pain severe possible

pain pain

Verbal Pain Intensity Scale

0–10 Numeric Pain Intensity Scale

No Moderate Worstpain pain possible pain

0 1 2 3 4 5 6 7 8 9 10

Visual Analog Scale

No Pain

“Faces” Scale

Worstpossible

pain

36 hrs 40 hrs 44 hrs 48 hrs

Name:

28 hrs 32 hrs

POST-OPERATIVE PAIN ASSESSMENT GRAPH FOR 1ST 48 HRS

3 Inability to sleep / intractable pain

2

1

0 Patient asleep / no pain / comfortable.

Sleep pattern altered / severe pain.

24 hrs16 hrs 20 hrs

0

12 hrsPost-Operative time (hrs) 0 hrs 4 hrs 8 hrs

Blood Pressuremm of Hg

Analgesics

Pulse Rate/min

2

1

3

% PAIN RELIEF(Coin Scale)

50%

75%

0-25 %

No sleep disturbance / moderate pain.

Pain Symbol

Time (O'clock)

100%

Operation

BONICA(1990) HAS ESTIMATED THAT;

15-20% OF POPULATION HAVE ACUTE PAIN

25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN

GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF

PREVENT INITIAL EXCITATION OF NOCICEPTIVE NERVES:NSAIDS

INTERRUPT PERIPHERAL NOCICEPTIVE TRANSMISSION: LOCAL ANAESTHETICS

ALTER SPINAL MODULATION: SPINAL/EPIDURAL NARCOTICS EPIDURAL LOCAL ANAESTHETICS EPIDURAL LA+NARCOTICS

GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF (CONTD)

INTERRUPT SPINAL CORD NOCICEPTIVE TRANSMISSION

ALTER CENTRAL PROCESSING OF NOCICEPTION INFORMATION:

OPIODS, NITROUS OXIDE ALTER EMOTIONAL RESPONSE TO PAIN,

ANXIETY OF ACUTE PAINS, DEPRESSION OF CHRONIC PAIN

ALTER BEHAVIOURAL RESPONSE TO PAIN

ACUTE PAIN

SOME EXAMPLES

POSTOPERATIVE

OBSTETRIC

TRAUMATIC

MEDICAL

SURGICAL

ORTHOPAEDIC

CANCER

METHODS OF ACUTE PAIN MANAGEMENT

MEDICATIONOPIOIDS PROSTAGLANDIN SYNTHETASE INHIBITORSOTHER DRUGS e.g KETAMINEINHALATIONAL AGENTSANXIOLYTICS

CHRONIC PAIN

MEDICAL

SURGICAL

MUSCULO-SKELETAL

NEUROLOGICAL

PSYCHOLOGICAL

METHODS OF CHRONIC PAIN MANAGEMENT

THE PAIN RELIEF CLINIC MEDICATION ANALGESIC PSYCHOTROPIC DRUGS ANTICONVULSANTS OTHER DRUGS

NEURAL BLOCKADE

TRIGGER POINT INJECTION

CRANIAL NERVE BLOCKS

EPIDURAL INJECTIONS

SYMPATHETIC BLOCKADE

SYMPATHETIC BLOCKADE

STELLATE GANGLION BLOCK COELIAC PLEXUS BLOCK LUMBAR SYMPATHETIC BLOCK INTRAVENOUS REGIONAL GUANETHIDINE BLOCK

ROUTES OF OPIOID ADMINISTRATION

INTRAMUSCULAR

INTRAVENOUS

SUBCUTANEOUS

ORAL

SUBLINGUAL

OTHER ROUTES: BUCCAL, NASAL, TRANSDERMAL

EPIDURAL / INTRATHECAL

SELECTION OF TECHNIQUE

DEPENDS UPON:

INTENSITY OF PAIN

SITE OF SURGERY

ANTICIPATED DURATION OF SEVERE PAIN

PHYSICAL STATUS OF THE PATIENT

NURSING STAFF

CHOICE OF ANALGESIA ACCORDING TO SURGERY

OPERATIONS ABOVE C4

SYSTEMIC DRUGS

OPERATIONS FROM T1 TO S4

EPIDURALS

NERVE BLOCKS

IN SHORT

TWO TYPES OF DRUGS

OPIODS AND LOCAL ANAESTHETICS

WITH DIFFERENT METHODS OF ADMINISTRATION

PAIN RELIEF IN CHILDREN

SMALL CHILDREN DO FEEL PAIN

DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF

WHO ANALGESIC LADDER

PHANTOM LIMB PAIN

CANCER PATIENTS

EVERY YEAR 6 MILLION NEW PATIENTS ARE DIAGNOSED IN THE WORLD

MORE THAN 4 MILLION DIE

10% OF ALL DEATHS

70% OF PATIENTS HAVE PAIN

OTHER METHODS

FACET JOINT BLOCK FOR BACHACHE

RF of RF of Suprascapular Suprascapular NerveNerveFOR SHOULDER PAIN

CRPS (COMPLEX REGIONAL PAIN SYNDROME)

CATHETER IN EPIDURAL SPACE

IMPLANT WITH CATHTER

IMPLANT FOR BACHACHE

Thank You