1. Pain relief;
A basic human right
Yousf M. Tak
Consultant of Anesthesia
Security Forces Hospital Dammam KSA

2. Regards from Kashmir; a paradise on earth

3. Pain relief; A basic human right
 Pain is leading cause of ER visits and hospitalizations
 Pain is a common mode of presentation in patients with
sickle cell disease (SCD) but there is considerable
variability in the way SCD pain is managed

4. Pain relief; A basic human right
 Pain is common undertreated entity
 One of the factors contributing to poor pain management is
conflicting perceptions between patients, their families and
healthcare professionals about pain that is reported and
analgesia that is required (Stinson & Naser, 2003).

6. Pain relief; A basic human right
The most reliable indicator of the existence pain and its intensity
is the patient’s description

7. Pain relief; A basic human right
 The aim of the wise is not to secure pleasure, but to
avoid pain. Aristotle
 Pain is a worst lord of mankind than death itself.

8. Pain relief; A basic human right
 Tachycardia And elevated blood pressure
 Decreased Limb movement; increased risk of DVT
 Respiratory effects; shallow breathing , tachypnea, cough suppression
. due to increased risk of pneumonia & atelectasis
 Decreased GI Motility
 Increased catabolic demands

9. Pain relief; A basic human right
 Psychological effects of Pain
 Negative emotions: anxiety, depression
 Sleep deprivation
 Existential suffering: may lead to patients
seeking active end of life
 Immunologic Effects of pain
 Decrease natural killer cell counts
 Effects on other lymphocytes not yet defined

10. Pain relief; A basic human right
 5TH Vital Sign
 Basic human Right; Human rights watch

11. Pain relief; A basic human right
 Effective control of pain
 Lack of awareness among public
 Minimal knowledge among health providers

12. Pain relief; A basic human right
Pain Clinic

13. Modified WHO Analgesic Ladder
Quality of Life
Invasive treatments
Proposed 4th Step Opioid Delivery
Pain persisting or increasing
Step 3
Opioid for moderate to severe pain
Nonopioid Adjuvant
Pain persisting or increasing
Step 2
Opioid for mild to moderate pain
The WHO Nonopioid  Adjuvant
Ladder Pain persisting or increasing
Step 1
Nonopioid
 Adjuvant
Pain
Deer, et al., 1999

14. Pain relief; A basic human right

15. Pain relief; A basic human right

16. Pain relief; A basic human right

17. Pain relief; A basic human right
Pain relief; A basic human right

18. Pain relief; A basic human right
 Paediatric Scales

19. Pain relief; A basic human right
Table: Severity of pain (Using a simple pain score)
.
0
Mafee alam No Pain
1
Shoa alam Mild Pain
2
Nus nus alam Moderate pain
3
Kateer alam) Severe Pain

20. Acute Pain in Sickle Cell Disease
Somatic pain
 – Deep structures
 – Focal or referred
Visceral pain
 – Spleen, liver, lungs
 – Vague, poorly localized, referred, diffuse, dull-aching in character
 – Nausea, vomiting, sweating
 – Associated with muscle spasms, tenderness, hyperaesthesia

21. Comprehensive Regimen for the sickle cell disease pain
 Maintenance therapy with opioid analgesic
 Non opioid analgesic
 Rescue therapy for breakthrough pain
 Adjuvant therapy
 Anxiolytics/muscle relaxants
 Laxatives
 Non-pharmacologic therapy
 Incentive spirometry
 Hydration (1-1.5x maintenance)
 Physical: Heating pads, massage, TENS, acupuncture, physical therapy
 Behavioral: Relaxation, deep breathing, behavior modification, biofeedback
 •Psychological: cognitive therapies, distraction, social support, hypnotherapy

22. Pain relief; A basic human right
 WHO Pain Ladder

23. Meperidine
 Shorter duration of action (1-2 hours only )
 Seizures on repeated administration
 Dermal and sub dermal fibrosis on I.M injection
Pethidine
 Narrow therapeutic index
 Norpethidine > Antagonistic
 Seizures on repeated administration

24. Pain relief; A basic human right

25. Pain relief; A basic human right
S.No Severity of pain Regimen
1 Mild Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
2 Moderate Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
+
Tramadol50-100mgs Q 8H
3 Severe Paracetomol 0.5g to 1g every 8H /
Lornoxicam4-8 mg Every 12-24 H
+
Morphine 5-mgs Q 8 H

26. Pain relief; A basic human right
PRN Schedule Illogical
Pain Cycle (Basal + Incident + Breakthrough Pain
Start (1Hr)} Asses} Reassess} Adjust
Tapering and not abrupt withdrawl

27. Pain relief; A basic human right
NSAIDS
 Bone Pain
 Opiod Sparing
 Ceiling Effect
Opiods
 Potent analgesics
 Safety Profile

28. Pain relief; A basic human right
Addiction
Nightmare for physician
Curse for the patient

29. Pain relief; A basic human right
 When asked, 59% of the patients desired that oral non-
opioid analgesics be prescribed while 31% were not
bothered about what analgesic was given. Only 8%
requested opioids.
 A total of 65% of the patients did not require hospital
admission but were observed in the day-care unit and
allowed home within 24 h. Only 17% required hospital
admission for more than a week.

30. Pain relief; A basic human right
 Prevention of Pain
 Triggers of pain: viral illness,
 infection/sepsis, stress, extreme exercise,
 change in temperature, change in altitude
 Fluids (2 glasses of water q 2 hours)
 Avoiding extreme temperatures, activities (e.g. swimming in cold
water)
 Regular moderate exercise
 Penicillin prophylaxis to prevent infection

31. STAY
PAINFREE