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ACUTE PAIN

ACUTE PAIN. Ahmed Ghaleb, MD UAMS Director Pain Medicine. PAIN. “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain 6:249, 1979 IASP. What Is Pain ?.

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ACUTE PAIN

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  1. ACUTE PAIN Ahmed Ghaleb, MD UAMS Director Pain Medicine

  2. PAIN “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain 6:249, 1979 IASP

  3. What Is Pain ? • Pain is a Subjective Experience • In evaluating Pain, clinicians must remind themselves that their eyes do not measure pain. • It is the nature and disposition of nearly all professionals to underestimate the magnitude of Central Pain.

  4. Classification of pain

  5. CLASSIFICATION

  6. CLASSIFICATION

  7. ACUTE PAIN • Is Defined as a sharp or having a short and relatively severe course. • All pain syndromes began as an ACUTE PAIN, becoming chronic only after persisting beyond the course of expected healing of the causative stimulus

  8. COMMON ACUTE PAIN SYNDROMES • POST OPERATIVE PAIN • Traumatic injury-related pain • Burn pain • Acute Herpes Zoster • Sickle cell pain • Cancer-related pain • Headache

  9. Chest Pain - Angina - Esophagitis - Pleuritic pain Abdominal pain - Acute Pancreatitis - Acute abdomen - Renal colic Musculoskeletal pain Neurogenic pain - Herniated disk - Nerve compression Ischemic pain - PVD COMMON ACUTE PAIN SYNDROMES

  10. POST OPERATIVE PAIN • Planned and deliberately inflicted • Iatrogenic tissue injury • Known anticipated time of onset • It can be approached using a preventive (preemptive ) treatment scheme • Acute in origin, pain last less than four weeks • Decrease with healing process

  11. POST OPERATIVE PAIN Despite its common occurrence, predictability, and its known cause, the management of Post operative pain remains inadequate treated in many cases.

  12. FACTORS INFLUENCING ACUTE POST OPERATIVE PAIN MANAGEMENT • Age, patient weight, culture, gender • Patient preoperative pharmacological and physiological management • Anesthetic management before, during and after surgery • Psychological factors • Anxious patient Aggressive • Angry Control of medical care

  13. FACTORS WHICH INCREASE PERIPHERAL PAIN RECEPTORS RESPONSIVENESS • Increased efferent sympathetic activity • Changes in the microcirculatory • blood supply • Physical activity • Chemical environment , e.g. H+ ions • Endogenous algesic substances • Prostaglandins • Prostacyclin • Serotonin • Thromboxanes • Bradykinin

  14. CENTRAL SENSITIZATION • Due to action of neuropeptides • Excitatory amino acids (EAA) • i.e. Aspartate and Glutamate upon neurokinin • (NK) • N- methyl – D aspartate (NMDA) • Alpha amino- 3 hydroxy - 5 methyl- 4 isoxazole • propionic acid • Substance P↔ release EAA cause increase • responsiveness of dorsal horn WDR neuron to • NMDA

  15. ROUTES USED FOR ANALGESICS DELIVERY FOR POST OPERATIVE PAIN MANAGEMENT • Intramuscular or Subcutaneous • Intravenous - Bolus injection • Patient controlled analgesia • Rectal administration • Epidural analgesia • Intrathecal • Intraosseous • Intrapleural • Transmucosal • Intravesical

  16. ALTERNATIVE METHODS OF ANALGESIA • Neural blockade • Local blockade • Peripheral nerve block • Plexus analgesia • Selective nerve block • Intercostal • Iliohypogastric • Ilioinguinal • Femoral nerve • Sciatic nerve block

  17. ALTERNATIVE METHODS OF ANALGESIA • Transcutaneous nerve stimulation • Cryoanalgesia • Intrapleural • Inhalation Analgesics • Nitrous oxide • Penthrane • Trichloroethylene • Psychological methods • Self Hypnosis Imaging • Audio control- music Biofeedback • Distraction

  18. INTRAMUSCULAR INJECTION • Inadequate pain relief • Unpredictable drug absorption • Analgesic onset delayed • Effectiveness is unpredictable • Individual variation in achieving MEAC • (Minimal effective analgesic concentrate) • Effect of body temperature and perfusion has direct • correlation, i.e. hypovolemia local temperature

  19. PATIENT CONTROL ANALGESIA (PCA) • Access to small, IV doses of opioid analgesics on as required basis. • Provide the ability to select the level of acceptable analgesia versus side effects. • Psychological benefit of patient feeling in control of their pain.

  20. PATIENT CONTROL ANALGESIA (PCA) • Make it work: - Opioid - Dose - Continuous or demand or both - Bolus - Lockout interval - Total dose limit ( 1 or 4 hour limit)

  21. PATIENT CONTROL ANALGESIA (PCA)

  22. NEUROAXIAL BLOCK • Spinal Analgesia - Continuous spinal - Single injection of opioid. • Epidural Analgesia - Continuous epidural - Single injection

  23. SPINAL ANALGESIA • Is produced by modulation of nociceptive transmission at the spinal dorsal horn • Single opioid injection is the most popular route for analgesia

  24. EPIDURAL

  25. BENEFITS OF EPIDURAL ANALGESIA • Improved pulmonary function • Decreased perioperative cardiac complications • Earlier mobilization • Earlier return of bowel function • Shorter hospital stay • Low incidence of side effects • Opiates, local anesthetics & other drugs can be used • Prevent thromboembolism

  26. NERVE BLOCK • Brachial Plexus Block ( Upper extremities) - Interscalene block - Supra and infra-clavicular block - Axillary's block • Lower extremities: - Lumbar plexus block. - Sciatic block, Popliteal block - Femoral block

  27. BRACHIAL PLEXUS BLOCK

  28. LOWER EXTREMITIES BLOCK

  29. pseudoaddiction • unlike true addiction, is a syndrome resulting from chronic undertreatment of pain . • It is important to differentiate between addiction and pseudoaddiction. In pseudoaddiction, the individual may exhibit drug-seeking behavior, but such behavior is due to inadequately controlled pain . If that patient's pain were appropriately managed, such behavior would dissipate

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