Acute Pain - Christchurch Hospital · Pain & Suffering ‘an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of

NETP: 2015

Acute Pain

Mr. & Mrs. Munster were the first television couple

to be seen sleeping together in the same bed

Pain & Suffering

‘an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage’

International Association for the Study of Pain

Suffering involves the experience of pain & additionally the complex context that the individuals pain occurs within, the multiple issues that must be endured

The Science of Nociception

Nociceptors = detect noxious stimuli

- heat

- irritating chemicals

- intense mechanical stimulation

Signals are transmitted to the spinal cord via first order neurons - A-delta δ fibers

- C-fibers

Second order neurons cross over & continue upwards in the anterolateral spinothalamic tracts to the thalamus & the cerebral cortex

The message is perceived as pain

Physiologic Pain

Rapidly perceived

nontraumatic

discomfort

of very short

duration

Nociceptive Pain

Noxious perception resulting from

cellular changes

following surgical,

traumatic or

disease

related

injuries

Neuropathic Pain

Pain initiated or

caused by a

pathological lesion

or dysfunction

Pain Assessment

The single most

reliable indicator

of the existence

and intensity of

pain and any

resultant distress

is the patients

self report

If you want to

know if your

patient is in pain

- ask them and

believe what

they say

Fears & Misconceptions

Fear of addiction

Fear of tolerance

Fear of respiratory depression

Underestimation of pain

Misunderstanding opioid legal regulations

Reserving stronger analgesia

Pain Management a

Fundamental Human Right

Evidence identifies pain assessment is effective when:

- it is regularly presented

- uses a patient-matched tool

- acknowledges variables

Treatment of Acute Pain

Multimodal approach

Analgesic algorithms

Assessment:

- frequent & regular

- pain on rest & movement

- sedation score

- respiratory rate

Consequences of Undertreated Pain

Suffering

Complications

Death

Adult Opioid Policy

The right dose is enough

Individualised Analgesia

Regimens

Dose

Route

Dose interval

Opioid naïve patient

Opioid experienced patient

Addiction

OPIOID NAÏVE OR

OPIOID EXPERIENCED

Opioids, Opiates & Narcotics

Both naturally occurring & synthetic molecules

that produce effects by action at opioid

receptors

Opioid Analgesia

Foundational drug in the management of moderate severe nociceptive pain

Morphine

Pethidine

Fentanyl

Alfentanil

Methadone

Oxycodone

Codiene

Naloxone

Opioid antagonist that competitively

displaces opioid analgesia from their receptor

sites, thus reversing their effects

Used to reverse adverse effects or overdose

effects of opioid agonists

Adjuncts

Tramadol

Cox2 Parecoxib

Paracetamol

Magnesium

Ketamine

Gabapentin

Clonidine

Amitriptyline

Tolerance

Drug tolerance is the

gradual decrease in

the effectiveness of a

drug given repeatedly

over a period of time:

if tolerance develops

higher doses are

required to achieve

the same effect

Dependence

Manifested by withdrawal symptoms after the

drug is suddenly removed

May be psychological as well as physiological

Symptoms include stress response signs;

sweating, nausea, vomiting, tremors, mood

changes

Addiction

Addiction involves inseparable biological

and behavioral components. It is the

quintessential

biobehavioral

disorder