Pain ManagementVinoo DissanayakeDecember 29, 2006

Pain

Poena (Latin); fine or penalty. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Pain Categories

►Acute►Somatic►Visceral

►Chronic►“Deafferentation

Pain”►“Sympathetically

maintained pain”►Nociceptive►Neuropathic

Pain Receptors

Nociceptors– Aδ fibers (fast)– C fibers (slow)

Anatomy of Pain

• Dorsal Column-Medial Lemniscus

• Spinoreticular Tract

• Spinomesencephalic Tract

• Spinothalamic Tract

Anatomy of Pain

Descending pathwaysNeurotransmitter

release•Enkephalins•Dynorphins•Beta-

Endorphins•Serotonin•Norepinephrine

The Systemic Response to Pain

► General

► Cardiovascular

► Respiratory

► GI/GU

► Endocrine

► Hematologic

► Immunologic

Pain Evaluation

► VAS scale and McGill questionnaire

► Minnesota Multiphasic Personality Inventory and Beck Depression Inventory

► Electromyography► Nerve Conduction

Studies► Thermography

Pain Modulation

Neural Blockade

Somatic Blocks► Trigeminal Nerve Blocks► Facial Nerve Block► Occipital Nerve Block► Phrenic Nerve Block► Suprascapular Nerve

Block► Cervical Paravertebral

Nerve Block► Thoracic Paravertebral

Nerve Block► Lumbar Paravertebral

Nerve Block► Lumbar Medial Branch &

Facet Blocks► Trans-Sacral Nerve Block► Pudendal Nerve Block

Neural BlockadeSympathetic Blocks

► Cervicothoracic Block► Thoracic Sympathetic

Chain Block► Celiac Plexus Block► Splanchnic Nerve

Block► Lumbar Sympathetic

Block► Hypogastric Plexus

Block► Ganglion Impar Block► Intravenous Regional

Sympathetic Blockade

Pharmacologic Methods

► AntidepressantsAntidepressants► AnticonvulsantsAnticonvulsants► NeurolepticsNeuroleptics► CorticosteroidsCorticosteroids► Systemic Local Systemic Local

AnestheticsAnesthetics

Therapeutic Adjuncts

► Psychological techniques

► Physical therapy► Acupuncture► Electrical

Stimulation

Outpatient Treatment

► Oral Analgesics► COX Inhibitors► Opioids

► Local Anesthetics

Inpatient Treatment

► Opioids► Peripheral Nerve

Blocks► Central Neuraxial

Blocks & Intraspinal Opioids

Cancer Pain

► Oral Opiate Therapy

► Transdermal Opioids► Parenteral Therapy► Intraspinal Opioids► Neurolytic Techniques

References

• Pain Management. Lange Clinical Anesthesiology. Morgan, Edward, et.al.

• http://www.medscape.com/viewarticle/534650_print

• http://en.wikipedia.org/wiki/Pain

• http://www.emedicine.com/neuro/topic514.htm