Pruritus and pain management in EB - PowerPoint PPT Presentation

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    1. Pruritus and pain management in EB Jemima Mellerio St Johns Institute of Dermatology & Great Ormond Street Hospital London UK

    3. Pain in EB Pain is a feature for all people with EB Individual: the same tissue damage may cause different level of pain in different people The same procedure may cause different levels of pain at different times in an individual

    4. Pain in EB: assessment Individual and patient-focused Cultural and social influences Use a recognised tool e.g. visual analogue scale, Mc Gill pain questionnaire, pictorial

    10. Inflammation of skin and mucosae Neuropathic pain Constipation Contractures Osteoporosis

    11. Pain in EB: general measures WHO analgesia ladder

    12. If anxiety, consider midazolam May require long-acting opioid for chronic pain e.g. MST Fentanyl lozenges useful for procedural and break-through pain Neuropathic pain may respond to amitriptyline, nortriptyline, gabapentin or pregabalin Pain in EB: general measures

    31. References Fine JD et al. Assessment of mobility, activities and pain in different subtypes of epidermolysis bullosa. Clin Exp Dermatol 2004; 29: 122-7. Herod J et al. Epidermolysis bullosa in children: pathophysiology, anaesthesia and pain management. Paediatr Anaesth 2002; 12: 388-97. Watterson G et al. Peripheral opioids in imflammatory pain. Arch Dis Childhood 2004; 89: 679-81.