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Pain Control

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