1 / 25

Dr Dietmar Hartmann MD FRCA FFPMRCA

Tayside Neuropathic Pain Guidelines 8th of June 2011 West Park, Dundee. Dr Dietmar Hartmann MD FRCA FFPMRCA. Components of pain. nociception perception of pain suffering pain behaviour. Artist Statement

tien
Download Presentation

Dr Dietmar Hartmann MD FRCA FFPMRCA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Tayside Neuropathic Pain Guidelines 8th of June 2011 West Park, Dundee Dr Dietmar Hartmann MD FRCA FFPMRCA

  2. Components of pain • nociception • perception of pain • suffering • pain behaviour

  3. Artist Statement I picture myself as the woman in the painting because I feel I am constantly fighting against a tidal wave of pain in order to achieve some quality of life. I am in danger of losing the fight and giving up.

  4. by Irene Tracey & Patrick Mantyh

  5. Types of pain • Nociceptive pain An appropiate physiologic response to painful stimuli via an intact nervous system • Neuropathic pain An inappropiate response caused by a dysfuntion in the nervous system

  6. Diagnosis • Common pain descriptors: burning, tingling, shooting or excessive sensitivity • Sensory examination: Allodynia (pain from an innocuous stimulus e.g.cotton wool), hyperalgesia (more pain than expected from a stimulus such as pinprick) • Note: many patients will have mixed pain syndromes, with nociceptive and neuropathic features, use this algorithm along with standard analgesics.

  7. Holistic Assessment • Consider the following when selecting antidepressant or anticonvulsant first-line therapy for Neuropathic pain. • Work/shift patterns • Poor sleep • Previous failed treatments • Responsibilities e.g. main carer/dependants/return to work issues

  8. Anticonvulsant – Gabapentin • Titrate according to dosing regime • Trial for at least 4 weeks Consider if: • Contraindication to tricyclic antidepressant • Night sedation would be problematic (e.g. main carer, shift worker) • Poor drug tolerance, Gabapentin is often better tolerated than amitriptyline

  9. Tricyclic antidepressant – Amitriptyline • Titrate from a low dose (10- 20 mg) • Titrate for at least 4 weeks Consider first line choice if: • Poor sleep • Poor compliance with medication (once daily dosage) • Polypharmacy specifically large numbers of tablets/day

  10. Many patients may require a COMBINATION of tricyclic and anticonvulsant therapy

  11. Anticonvulsant - Pregabalin • Use third line if not achieved adequate pain relief or not tolerated first and second line treatments with tricyclic antidepressant +/- gabapentin • Can be used in combination with a tricyclic antidepressant  • Not to be co-prescribed with gabapentin • Titrate slowly according to dosing regime

  12. Neuropathic pain Implementing NICE guidance March 2010 NICE clinical guideline 96

  13. Offer oral duloxetine: start at 60 mg/day (a lower starting dose may be appropriate for some people); titrate to effective dose or maximum tolerated dose – maximum 120 mg/day If duloxetine is contraindicated, offer oral amitriptyline* First-line treatment:diabetic neuropathy

  14. LidocaineLignocaine

  15. Multidisciplinary approach • Physiotherapy • Occupational Therapy • Psychology • Pain Management Programmes

  16. Other therapies • TENS • Acupuncture • Nerve Blocks • Surgical Lesioning • Intrathecal Drug Delivery Systems • Spinal cord stimulation • Motor cortex stimulation • Deep brain stimulation • repetitive Transcranial Magnetic Stimulation

  17. Pain Specialist AMAZING NEW ALL NATURAL FORMULAPAIN SPECIALIST DECLARES WAR ON PAIN!You can fight back against:- Osteoarthritis- Rheumatoid Arthritis- Fibromyalgia- And more!Pain Specialist is an all-natural supplement made from the finest blend of herbs and ingredients that has given people a new lease on life! Never again be terrorized by chronic pain conditions! Backed by a 100% Money Back "Empty Bottle" 30-Day Guarantee.Try Your First Order Completely Risk Free! BUY NOW

  18. Any Questions?

More Related