NETP: 2015 Acute Pain
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