Pain Control
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Pain Control Presentation Transcript

  • 1. Pain Control.
  • 2. Pain Control Methods.
    • Pharmacological methods.
      • How to decide where to start.
      • Individual drugs.
    • Non-pharmacological methods.
      • Physical methods.
      • Psychological methods.
  • 3. What is pain?
    • “ An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Each individual learns the application of the word through experiences related to injury in early life.”
    • “ Pain is what the patient says it is.”
    .
  • 4. Pharmacological Methods of Pain Control.
    • Paracetamol
    • NSAIDS
    • Opiates
    • Local Anaesthetics
    • Nitrous Oxide
    • Medications aimed at treating the underlying pathology e.g. GTN for Angina
    .
  • 5. WHO Pain Ladder. .
  • 6. Paracetamol. .
  • 7. Paracetamol.
    • Weak inhibitor of prostaglandin synthesis.
    • However no anti-inflammatory effect.
    • Is there another mechanism of action?
    .
  • 8. Paracetamol.
    • Side effects.
    • Rashes
    • Renal Impairment
    • Increased risk of hepato-toxicity in liver failure.
    .
  • 9. Aspirin. .
  • 10. Meadowsweet. .
  • 11. NSAIDs
    • Mechanism of action
    • Inhibition of cyclo-oxygenase enzyme that converts Platelet Activating Factor into Prostaglandins.
    .
  • 12. NSAIDs
    • Cautions and Contraindications.
    • Hypersensitivity to Aspirin or NSAIDs
    • Active Peptic Ulceration.
    • Pregnancy – premature closure of Ductus Arteriosus.
    • Renal Impairment.
    .
  • 13. NSAIDs
    • Side effects.
    • Hypersensitivity.
    • GI Bleeding – less common with Ibuprofen
    • Bronchospasm.
    • Renal failure.
    • Fluid retention.
    .
  • 14. Opiates. .
  • 15. Opiates.
    • Mechanism of action –
    • Agonists/Partial Agonists at mu type Opiate Receptors.
    • These are mainly in CNS, but also found in other tissues.
    .
  • 16. Opiates.
    • Side effects.
    • Type A – Related to opiate receptors inside CNS.
    • Hallucinations.
    • Dysphoria.
    • Respiratory depression.
    • Vomiting.
    • Related to opiate receptors outside CNS.
    • Constipation.
    • Urinary retention.
    • Hypotension.
    .
  • 17. Opiates.
    • Type B - Non opiate receptor mediated histamine release.
    • Urticaria
    • Anaphylaxis
    • ARDS
    • These usually respond to anti-histamines not naloxone.
    .
  • 18. Local Anaesthetics. .
  • 19. Novocaine. .
  • 20. Local Anaesthetics.
    • Mechanism of action.
    • Defuse into axons in non ionised form.
    • Ionised form blocks fast sodium channels from the inside.
    .
  • 21. Local Anaesthetics.
    • Side effects - CNS.
    • Circumoral numbness.
    • Lightheadedness.
    • Tinnitus.
    • Convulsions.
    • Coma.
    • Respiratory arrest.
    .
  • 22. Local Anaesthetics.
    • Side effects - CVS.
    • Bradydysrhythmias.
    • Loss of vasomotor tone.
    • Ventricular tachydysrhythmias.
    • Also,
    • Allergic reactions.
    • Nerve injuries.
    • Infarction of appendages with adrenaline.
    • Pain at injection site.
    .
  • 23. Local Anaesthetics.
    • Lignocaine 3mg/kg
    • (double mixed with 1:200 000 adrenaline)
    • Bupivucaine 2mg/kg
    • Prilocaine 5mg/kg
    .
  • 24. Entonox.
    • Mixture of 50% Oxygen and 50% Nitrous Oxide.
    • Unknown mechanism of action.
    • Doesn’t cause respiratory depression.
    .
  • 25. Entonox.
    • Cautions and Contraindications.
    • Nitrous oxide defuses out of the blood
    • faster than Nitrogen dissolves into it.
    • Entonox should not be given in any situation where expansion of a gas filled space may have an adverse effect on the patient.
    .
  • 26. Entonox.
    • Cautions and Contraindications.
        • Pneumothorax
        • Intestinal Obstruction/Grossly distended abdomen.
        • Diving injuries.
        • Severe head injuries (maybe pneumocephalus)
        • Middle ear surgery.
        • Unconscious patients.
        • Severe facial trauma.
    .
  • 27. Other drugs.
    • Amitryptaline.
    • Gabapentin.
    .
  • 28. Non Pharmacological methods of pain control.
    • Physical.
    • Psychological.
    .
  • 29. Stabilisation. .
  • 30. “ Rubbing it better”
    • Gate theory of pain
    • Topical preparations
    • Acupressure?
    • Kober A, Scheck T, Greher M, Lieba F, Fleischhackl R, Fleischhackl S, Randunsky F, Hoerauf K (2002).
    • Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomised, double blinded trial.
    • Anaesth Analg 95(3) 723-727.
    .
  • 31. Non-pharmacological methods of Pain Control. .
  • 32. Remember a time when you were alone and afraid? .
  • 33. Remember a time when you were happy? .
  • 34. “ children tolerate pain well” .
  • 35. Distraction. .
  • 36. Any questions?
    • ?
    .
  • 37. Summary.
    • How to choose which drugs to use for pain control based on;
      • Aetiology of pain.
      • Amount of pain.
      • Individual drugs.
    • Physical methods of pain control.
    • Psychological methods of pain control.
    .
  • 38. Thank You. .