METHODS OF PAIN RELIEF

1. METHODS OF PAIN RELIEF BY BRIG M. SALIM Professor of Anaesthesiology, Islamic International Medical College, Rawalpindi

3. PAIN -DEFINITION ‘AN UNPLEASANT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE’ Ref: International Association for Study of Pain

6. CLASSIFICATION OF PAIN • ACUTE • CHRONIC • NOCICEPTIVE • NEUROPATHIC • PSYCHOGENIC

7. MEASUREMENT OF PAIN • VISUAL ANALOGUE SCALE (VAS) • VERBAL RATING SCALE • McGILL PAIN QUESTIONNAIRE • PAKISTAN COIN SCALE (PCS)

8. Pain Assessment Scales Visual Analog Scale Verbal Pain Intensity Scale No Mild Moderate Severe Very Worst pain pain pain pain severe possible pain pain Worstpossiblepain No Pain 0–10 Numeric Pain Intensity Scale “Faces” Scale 0 1 2 3 4 5 6 7 8 9 10 No Moderate Worst pain pain possible pain

11. BONICA(1990) HAS ESTIMATED THAT; • 15-20% OF POPULATION HAVE ACUTE PAIN • 25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN

12. GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF • PREVENT INITIAL EXCITATION OF NOCICEPTIVE NERVES:NSAIDS • INTERRUPT PERIPHERAL NOCICEPTIVE TRANSMISSION: LOCAL ANAESTHETICS • ALTER SPINAL MODULATION: • SPINAL/EPIDURAL NARCOTICS • EPIDURAL LOCAL ANAESTHETICS • EPIDURAL LA+NARCOTICS

13. GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF (CONTD) • INTERRUPT SPINAL CORD NOCICEPTIVE TRANSMISSION • ALTER CENTRAL PROCESSING OF NOCICEPTION INFORMATION: OPIODS, NITROUS OXIDE • ALTER EMOTIONAL RESPONSE TO PAIN, ANXIETY OF ACUTE PAINS, DEPRESSION OF CHRONIC PAIN • ALTER BEHAVIOURAL RESPONSE TO PAIN

14. ACUTE PAIN SOME EXAMPLES • POSTOPERATIVE • OBSTETRIC • TRAUMATIC • MEDICAL • SURGICAL • ORTHOPAEDIC • CANCER

15. METHODS OF ACUTE PAIN MANAGEMENT MEDICATION • OPIOIDS • PROSTAGLANDIN SYNTHETASE INHIBITORS • OTHER DRUGS e.g KETAMINE • INHALATIONAL AGENTS • ANXIOLYTICS

16. CHRONIC PAIN • MEDICAL • SURGICAL • MUSCULO-SKELETAL • NEUROLOGICAL • PSYCHOLOGICAL

17. METHODS OF CHRONIC PAIN MANAGEMENT • THE PAIN RELIEF CLINIC MEDICATION • ANALGESIC • PSYCHOTROPIC DRUGS • ANTICONVULSANTS • OTHER DRUGS

18. NEURAL BLOCKADE • TRIGGER POINT INJECTION • CRANIAL NERVE BLOCKS • EPIDURAL INJECTIONS • SYMPATHETIC BLOCKADE

19. SYMPATHETIC BLOCKADE • STELLATE GANGLION BLOCK • COELIAC PLEXUS BLOCK • LUMBAR SYMPATHETIC BLOCK • INTRAVENOUS REGIONAL GUANETHIDINE BLOCK

20. ROUTES OF OPIOID ADMINISTRATION • INTRAMUSCULAR • INTRAVENOUS • SUBCUTANEOUS • ORAL • SUBLINGUAL • OTHER ROUTES: BUCCAL, NASAL, TRANSDERMAL • EPIDURAL / INTRATHECAL

21. SELECTION OF TECHNIQUE DEPENDS UPON: • INTENSITY OF PAIN • SITE OF SURGERY • ANTICIPATED DURATION OF SEVERE PAIN • PHYSICAL STATUS OF THE PATIENT • NURSING STAFF

22. CHOICE OF ANALGESIA ACCORDING TO SURGERY • OPERATIONS ABOVE C4 SYSTEMIC DRUGS • OPERATIONS FROM T1 TO S4 EPIDURALS • NERVE BLOCKS

23. IN SHORT TWO TYPES OF DRUGS OPIODS AND LOCAL ANAESTHETICS WITH DIFFERENT METHODS OF ADMINISTRATION

24. PAIN RELIEF IN CHILDREN • SMALL CHILDREN DO FEEL PAIN • DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF

25. WHO ANALGESIC LADDER

26. PHANTOM LIMB PAIN

28. CANCER PATIENTS • EVERY YEAR 6 MILLION NEW PATIENTS ARE DIAGNOSED IN THE WORLD • MORE THAN 4 MILLION DIE • 10% OF ALL DEATHS • 70% OF PATIENTS HAVE PAIN

34. OTHER METHODS

38. FACET JOINT BLOCK FOR BACHACHE

39. FOR SHOULDER PAIN

40. CRPS (COMPLEX REGIONAL PAIN SYNDROME)

41. CATHETER IN EPIDURAL SPACE

42. IMPLANT WITH CATHTER

43. IMPLANT FOR BACHACHE

44. Thank You