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
CLASSIFICATION OF PAIN ACUTE
CHRONIC
NOCICEPTIVE
NEUROPATHIC
PSYCHOGENIC
MEASUREMENT OF PAIN
VISUAL ANALOGUE SCALE (VAS) VERBAL RATING SCALE McGILL PAIN QUESTIONNAIRE PAKISTAN COIN SCALE (PCS)
Pain Assessment Scales
No Mild Moderate Severe Very Worstpain pain pain pain severe possible
pain pain
Verbal Pain Intensity Scale
0–10 Numeric Pain Intensity Scale
No Moderate Worstpain pain possible pain
0 1 2 3 4 5 6 7 8 9 10
Visual Analog Scale
No Pain
“Faces” Scale
Worstpossible
pain
36 hrs 40 hrs 44 hrs 48 hrs
Name:
28 hrs 32 hrs
POST-OPERATIVE PAIN ASSESSMENT GRAPH FOR 1ST 48 HRS
3 Inability to sleep / intractable pain
2
1
0 Patient asleep / no pain / comfortable.
Sleep pattern altered / severe pain.
24 hrs16 hrs 20 hrs
0
12 hrsPost-Operative time (hrs) 0 hrs 4 hrs 8 hrs
Blood Pressuremm of Hg
Analgesics
Pulse Rate/min
2
1
3
% PAIN RELIEF(Coin Scale)
50%
75%
0-25 %
No sleep disturbance / moderate pain.
Pain Symbol
Time (O'clock)
100%
Operation
BONICA(1990) HAS ESTIMATED THAT;
15-20% OF POPULATION HAVE ACUTE PAIN
25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN
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
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
ACUTE PAIN
SOME EXAMPLES
POSTOPERATIVE
OBSTETRIC
TRAUMATIC
MEDICAL
SURGICAL
ORTHOPAEDIC
CANCER
METHODS OF ACUTE PAIN MANAGEMENT
MEDICATIONOPIOIDS PROSTAGLANDIN SYNTHETASE INHIBITORSOTHER DRUGS e.g KETAMINEINHALATIONAL AGENTSANXIOLYTICS
CHRONIC PAIN
MEDICAL
SURGICAL
MUSCULO-SKELETAL
NEUROLOGICAL
PSYCHOLOGICAL
METHODS OF CHRONIC PAIN MANAGEMENT
THE PAIN RELIEF CLINIC MEDICATION ANALGESIC PSYCHOTROPIC DRUGS ANTICONVULSANTS OTHER DRUGS
NEURAL BLOCKADE
TRIGGER POINT INJECTION
CRANIAL NERVE BLOCKS
EPIDURAL INJECTIONS
SYMPATHETIC BLOCKADE
SYMPATHETIC BLOCKADE
STELLATE GANGLION BLOCK COELIAC PLEXUS BLOCK LUMBAR SYMPATHETIC BLOCK INTRAVENOUS REGIONAL GUANETHIDINE BLOCK
ROUTES OF OPIOID ADMINISTRATION
INTRAMUSCULAR
INTRAVENOUS
SUBCUTANEOUS
ORAL
SUBLINGUAL
OTHER ROUTES: BUCCAL, NASAL, TRANSDERMAL
EPIDURAL / INTRATHECAL
SELECTION OF TECHNIQUE
DEPENDS UPON:
INTENSITY OF PAIN
SITE OF SURGERY
ANTICIPATED DURATION OF SEVERE PAIN
PHYSICAL STATUS OF THE PATIENT
NURSING STAFF
CHOICE OF ANALGESIA ACCORDING TO SURGERY
OPERATIONS ABOVE C4
SYSTEMIC DRUGS
OPERATIONS FROM T1 TO S4
EPIDURALS
NERVE BLOCKS
IN SHORT
TWO TYPES OF DRUGS
OPIODS AND LOCAL ANAESTHETICS
WITH DIFFERENT METHODS OF ADMINISTRATION
PAIN RELIEF IN CHILDREN
SMALL CHILDREN DO FEEL PAIN
DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF
WHO ANALGESIC LADDER
PHANTOM LIMB PAIN
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
OTHER METHODS
FACET JOINT BLOCK FOR BACHACHE
RF of RF of Suprascapular Suprascapular NerveNerveFOR SHOULDER PAIN
CRPS (COMPLEX REGIONAL PAIN SYNDROME)
CATHETER IN EPIDURAL SPACE
IMPLANT WITH CATHTER
IMPLANT FOR BACHACHE
Thank You
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