Pain Control

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  • Salicylic acid was first isolated from willow bark.
  • Salicylic acid purified from this in 1835, allowed mass production.
  • Pain Control

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

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