pain management - tech talk

8/10/2019 Pain Management - Tech Talk

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PAIN MANAGEMENT


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AIM

Background understanding on types of pain.

Understand the different types of analgesiaavailable and their side effects, use andcounselling.

Current optimal practice for label requirementsof analgesic medication.


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PAIN

The World Health Organisation (WHO) defines pain as:

An unpleasant sensoryor

emotionalexperience associated

with actualor potentialtissue

damage, or described in terms of

such damage.


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BACKGROUND

Pain Types

Nociceptive Pain activation of normal pain fibres inresponse to a stimulus (e.g. injury, disease orinflammation)

Neuropathic Pain injury or disease affecting theperipheral or central nervous system or both (e.g.phantom limb, spinal cord injury)


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BACKGROUND

Measuring Pain

Numerical Rating Scale

Visual Analogue Scale


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TYPES OF ANALGESIA

RegularBaseline pain management

PRN When required

Opioids

Morphine Oxycodone

Tramadol

Fentanyl

Non-Opioids

Paracetamol NSAIDs

Ibuprofen

Adjuvant

Gabapentin Amitriptyline

Pregabalin


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OPIOIDS

Use

Treatment of moderate to severe pain.

Side Effects & Management

Drowsiness monitor (better pain management e.g. panadol shouldreduce this side effect)

Nausea and vomiting

metoclopramide (first line at PAH) Constipation coloxyl & senna, movicol (regular or prn while on opioid)

Counselling

Avoid alcohol

Can make you dizzy when standing up too quickly (care in elderly)


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OXYCODONE

Label

Take ONE to TWO tablets every

FOUR to SIX hours when necessaryfor relief of severe pain.

WHEN REQUIRED

Should be on regular paracetamol to

limit opioid use.

Swallow whole ONE tablet TWICE a

day (every TWELVE hours)

REGULAR

Also available with naloxone as

Targin to prevent constipation


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MORPHINE

Most Common Formulations CR tablets MS Contin, Momex SR Oral Liquid Ordine

Labels CR tablets Take ONE tablet TWICE a day (every TWELVE hours).

**TO BE SWALLOWED WHOLE** **DO NOT CRUSH OR CHEW**

Liquid by metric measure

Counselling

Avoid alcohol


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BUPRENORPHINE

Counselling

Write date & time on the patch on application

Remove after 7 days and put new patch in a different area

Do not wear more than 2 patches at any time

Do not cut or divide patches

Patch Sublingual Tablets

Use Chronic moderate to severe pain Moderate to severe pain or opioiddependence

Label Apply ONE (1) patch to clean, dry

skin and replace ONCE a WEEK on

the same day. Carefully remove,

fold and discard used patch.

Place ONE (1) tablet under the tongue

and keep in place until dissolved. Do

not chew or swallow the tablet.


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NON OPIOIDS

Use

Mild moderate pain

Taken at regular doses to reduce baseline

moderate to severe pain hence reduce opioid

usage

Types

Paracetamol, Aspirin, NSAIDs.


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PARACETAMOL

Label Take ONE to TWO tablets FOUR times a day (when required).

Maximum of EIGHT paracetamol containing tablets in 24 hours.

Other Can cause liver damage if too much is taken

Care with alcohol

Side Effects Paracetamol is preferred to NSAIDs as it has fewer adverse effects


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NSAIDS

Examples Ibuprofen (Nurofen), Diclofenac (Voltaren), Naproxen, Indomethacin

Label Doses vary

Take with or soon after food

Counselling Do not take aspirin with NSAIDs

Side Effects/Management Nausea take with food

GI bleeding/ulceration may be taken with PPI (e.g. omeprazole)

Hypertension

often contraindicated in patients with cardiovascular disease


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ADJUVANT

Examples

Anticonvulsants Gabapentin Pregabalin Carbamazepine

Antidepressants

Amitriptyline Duloxetine

Use

Treatment of neuropathic (nerve) pain


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ANTICONVULSANTS

Most commonly

Gabapentin Pregabalin Now on PBS for neuropathic pain (not first line)

Side Effects

Sedation, dizziness, weight gain, rash

Pregabalin has more than Gabapentin

Counselling

Drowsiness avoid driving til you know how it affects you

Do not stop taking abruptly


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QUESTIONS?

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