pain - definition ‘ an unpleasant sensory and emotional experience associated with actual or...
TRANSCRIPT
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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
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CLASSIFICATION OF PAIN ACUTE
CHRONIC
NOCICEPTIVE
NEUROPATHIC
PSYCHOGENIC
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MEASUREMENT OF PAIN
VISUAL ANALOGUE SCALE (VAS) VERBAL RATING SCALE McGILL PAIN QUESTIONNAIRE PAKISTAN COIN SCALE (PCS)
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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
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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
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BONICA(1990) HAS ESTIMATED THAT;
15-20% OF POPULATION HAVE ACUTE PAIN
25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN
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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
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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
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ACUTE PAIN
SOME EXAMPLES
POSTOPERATIVE
OBSTETRIC
TRAUMATIC
MEDICAL
SURGICAL
ORTHOPAEDIC
CANCER
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METHODS OF ACUTE PAIN MANAGEMENT
MEDICATIONOPIOIDS PROSTAGLANDIN SYNTHETASE INHIBITORSOTHER DRUGS e.g KETAMINEINHALATIONAL AGENTSANXIOLYTICS
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CHRONIC PAIN
MEDICAL
SURGICAL
MUSCULO-SKELETAL
NEUROLOGICAL
PSYCHOLOGICAL
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METHODS OF CHRONIC PAIN MANAGEMENT
THE PAIN RELIEF CLINIC MEDICATION ANALGESIC PSYCHOTROPIC DRUGS ANTICONVULSANTS OTHER DRUGS
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NEURAL BLOCKADE
TRIGGER POINT INJECTION
CRANIAL NERVE BLOCKS
EPIDURAL INJECTIONS
SYMPATHETIC BLOCKADE
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SYMPATHETIC BLOCKADE
STELLATE GANGLION BLOCK COELIAC PLEXUS BLOCK LUMBAR SYMPATHETIC BLOCK INTRAVENOUS REGIONAL GUANETHIDINE BLOCK
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ROUTES OF OPIOID ADMINISTRATION
INTRAMUSCULAR
INTRAVENOUS
SUBCUTANEOUS
ORAL
SUBLINGUAL
OTHER ROUTES: BUCCAL, NASAL, TRANSDERMAL
EPIDURAL / INTRATHECAL
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SELECTION OF TECHNIQUE
DEPENDS UPON:
INTENSITY OF PAIN
SITE OF SURGERY
ANTICIPATED DURATION OF SEVERE PAIN
PHYSICAL STATUS OF THE PATIENT
NURSING STAFF
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CHOICE OF ANALGESIA ACCORDING TO SURGERY
OPERATIONS ABOVE C4
SYSTEMIC DRUGS
OPERATIONS FROM T1 TO S4
EPIDURALS
NERVE BLOCKS
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IN SHORT
TWO TYPES OF DRUGS
OPIODS AND LOCAL ANAESTHETICS
WITH DIFFERENT METHODS OF ADMINISTRATION
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PAIN RELIEF IN CHILDREN
SMALL CHILDREN DO FEEL PAIN
DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF
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WHO ANALGESIC LADDER
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PHANTOM LIMB PAIN
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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
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OTHER METHODS
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FACET JOINT BLOCK FOR BACHACHE
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RF of RF of Suprascapular Suprascapular NerveNerveFOR SHOULDER PAIN
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CRPS (COMPLEX REGIONAL PAIN SYNDROME)
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CATHETER IN EPIDURAL SPACE
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IMPLANT WITH CATHTER
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IMPLANT FOR BACHACHE
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Thank You