3. Pharmacologic interventions
1. Pre-medication assessment:
• Ask about allergy to medication, OTC (over the
counter), assess pain intensity after previous
dose of medication
2. Medication used to treat pain are:
• Opioids analgesic agents:
• NSAID:
• Local anesthetic agent:
• Tricyclic anti-depresent agents and anti-seizure
medication:
4. :Agents used to treat pain
• Opioids analgesic agent:
• It is given by IV, SC, oral, Intra-spinal, rectal,
and trans-dermal.
• Although oral is peripheral it is must be given
frequently in large amount.
• Adverse effect: respiratory depression (asses
it), tolerance, and sedation (pressure ulcer)
nausea and vomiting (prevented by anti-emetic
and hydration), constipation (laxatives and more
fluids or supp) or pruritus (antihistamine).
• Epidural opioids might cause urine retention
(catheter till patient is improved).
5. NSAID
• It thought to decrease enzyme involved in the
production of prostaglandin from inflamed tissue
it cause pain, fever and inflammation
• Ibubrufen is effective for mild to moderate pain
• It is releives post operative pain if it is give in
intra-operative stage.
• precaution with kidney dysfunction, dehydrated
and elderly patients.
• NSAIDS might increase the effect of warfarin
6. Local anesthetic agents
• It acts by blocking nerve ending when
applied directly to nerve fibers.
• They can be applied injury site or to
thoracic or abdominal surgery when
injected intercostly.
• Vasoconstrive agent is to be available in
case of toxicity.
7. Topical application
a. EMLA cream for pain of invasive
procedure as LP and IV lines.
b. Lidocaine 5% patch is another example.
c. Intra-spinal administration: it is through
epidural catheter to the nerve root.
8. Tricyclic antidepressant agents and
anti-seizure medication
• If pain is neurologic in origin is difficult to
treat so if it is associated with burning pain
the above named drugs might beresponsive.
• Its effects starts after 3 weeks
10. Routes of administration
• Parentral routes: (IV IM SC) are more rapid but
short duration. IV occurs within minutes.
Continues infusion provides continues effect. SC
given for severe pain and for who does not get
IV access.
• Oral route: used if patient tolerate oral
medication, if doses gradually increased chance
of respiratory depression is controlled, if
Parenteral route to oral to changes dose should
be carefully adjusted to prevent withdrawal
reaction.
11. • Rectal route: for patient who can not get
medication by other route, or with bleeding
disorder.
• Transdermal route: used to absorb
medication by skin to get consistent
opioids serum level. It is slowly and
systematically absorbed.
12. Intraspinal and epidural routes
• Infusion of medication to epidural space is
used to relieve pain in post operative
patient.
• Pain relieved from intra-spinal
administration of opioids is based on the
existence of opioids receptors in the spinal
cord.
• Headache, respiratory depression might
be caused by this route.
14. Teaching patient self care
• Explain the purpose of each medication,
time, side effects,
• Reassure pain can managed at home
• Instruct about assessment of pain,
administer medicaiton to releive pain,
• Allow self administration of medicaiton
• Instruct aobut respiratory depression with
opioids.
15. • Prevent or treat constipation
• Keep medication a way from children
16. • Continuity of care: home visiting in
necessary to ensure continuity of pain
management, ensure proper supply of
analgesics, assess items used (pump),
assess need to change medication
dose,,,,,,,,,,,,,,,,,,
17. Non pharmacological
• Massage: rubbing the skin and use of heat
and cold simulate the fiber that transmit
non-painful sensation.
• Thermal therapies: same, ice should be
placed at injury site immediately for 1520min after skin assessment and not in
patient with impaired circulation. Heat
therapy increase blood supply lead to
rapid healing.
18. • Transcutaneous electrical nerve
stimulation: TENS, pattery operated unit
with electrodes applied to skin to produce
vibration sensation in area, for acute and
chronic pain. It stimulate non pain
receptors.
20. • Distraction: focusing patient attention on
other than the pain. It stimulate the
descending control system. E.g: TV,
music, physical and mental exercise.
21. • Relaxation technique: relaxing the tense
muscle, as abdominal breathing in slow
and rhythmic rate, it helps in releiving
fatigue.
• Guided imagery:
• Hypnosis: by specialized person as
psychologist or with specialized nurse.
Patient might learn to do it themselves.
22. • Music therapy: for pain
and anxiety reduction.
• Alternative therapies: herbal therapy,
reflexology, acupressure, therapeutic
touch, macrobiotic dieting.
