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Chronic pain management
- 1. CHRONIC PAIN MANAGEMENT:TIPS AND STRATEGIES
- 2. PRESENTED BY DR.ABU BAKARSIDDIQUE ORTHOPAEDIC CONSULTANT SADAR HOSPITAL,CHUADANGA
- 3. HUGE IMPACT OFCR. PAIN Chronic pain is clearly a major health care problem in USA. Significant and costly problem in developed country and Throughout the industrialized world as well One third of total health care cost are involved in managing chronic pain management
- 4. CHRONIC PAIN Long lastingpain Persist beyond the usual course of an acute illness/injury(3-6 month since onset) Associated with a pattern of recurrence Invariably associated with chronic pathology Often accompanied with emotional symptoms
- 5. DISEASES/SYMPTOM? Pain perception isthe normal physiological responds Only non adapting sensory responds of the body.
- 6. PAIN PERCEPTION INCHRONIC PAIN Most of the investigators considered Chronic pain as a separate disease Allodynia and Hyperalgesia Parvated form pain responds
- 8. ALODYNIA Experience of painperception to a stimulus which is normally not painful. Abnormal nociceptive responds of neuron. Sensitization
- 10. HYPERALGASIA Abnormally increase pain perceptionto a stimulus which is normally painful but not so much. Hypersensitivity response of nociceptive nerve
- 11. WHY & HOWDOES IT HAPPEN
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- 14. acute Peripheral pain Soft tissuedamage Trauma,accident, Response well with analgesics,cold,rest,massa ge etc chronic Central Connective tissue.nerve, disc,joints,ligaments,cartilages etc Sequel of acute or chronic denovo Usually does not responds with analgesic alone
- 15. Table 2. ClinicalDifferentiations between Acute and Chronic Pain Acute Pain Chronic Pain Cause Usually obvious tissue damage,Pheripheral Multiple causes (malignancy,benign CTD) Onset Distinct onset Gradual or distinct onset. Duration Short, well characterized duration Persists after 3-6 months of healing Termination Resolves with healing Can be a symptom or diagnosis Purpose Serves a protective function Serves no adaptive purpose
- 16. CHRONIC PAIN Long lastingpain Persist beyond the usual course of an acute illness/injury(3-6 month since onset) Associated with a pattern of recurrence Invariably associated with chronic pathology Often accompanied with emotional symptoms
- 17. CHRONIC PAIN Unresolved acutepain. Persist beyond the usual course of an acute illness/injury(3-6 month since onset) Associated with a pattern of recurrence Invariably associated with chronic pathology Often accompanied with emotional symptoms
- 18. ACUTE PAINFULL CONDITIONWAS NOT TREATED ADEQUATELY ? Why unresolved? Or persistent?
- 19. Undertreated severe acutepain has dangerous consequences •Number of harmful physiological and psy chological effects •Emotional and physical suffering; • •.
- 20. UNDERTREATED ACUTE SEVEREPAIN HAS A DANGEROUS CONSEQUENCES Chronic Pain • Sleep disturbance • Cardiovascular effects • Impaired bowel movement. • Effects on respiratory function • Delayed mobilization • Delayed wound healing • Increase incidence of post surgical pain syndrome(PSPS)
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- 23. STRATEGIES OF MANAGEMENT Adequateand aggressive management of acute pain With its aetiology Primary factors Precipitating factors Psycho social factors Biopscychosocial approach:
- 24. CONTROVERSIES IN ANALGESICUSE Controversial Masking the diagnosis After diagnosis it can use for short period of time Combination of central and peripheral acting analgesic are superiority to non combined analgesic. Act good when prescribed with neuromodulating drugs
- 25. CENTRALLY ACTING DRUGS Antidepressant:a Amitriptyline,TCAdepressant,SNRIs,Mirtazipine, Nortriptylin Anticonvulsants: Gabapentin, Pregabalin. Tegretol Opioids:Morphin,Pethidine,Oximorphin,Methadones Opioids like drugs: Nelbuphin,Tramadol,Phentanyl,tapentadol Centrally acting muscle relaxant
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