Overview on pain management in MSF setting. Content: Types of pain Assess the pain and pain scales Treating pain according to the pain scale All of subjected will be discussed briefly and in perspective of our work MATERIALS: https://emedicine.medscape.com/article/1948069-overview#a3 https://www.change-pain.com/grt-change-pain-portal/change_pain_home/chronic_pain/physician/physician_tools/picture_library/en_EN/312500026.jsp MSF Clinical Guidelines and MSF protocols

1. Trainer’s name:
Department/Staff:
Date:
Project:
Validation:
OVERVIEW ON PAIN
MANAGEMENT

2. CONTENT:
• Types of pain
• Assess the pain and pain scales
• Treating pain according to the pain scale
All of subjected will be discussed briefly and in perspective of our work
MATERIALS:
https://emedicine.medscape.com/article/1948069-overview#a3
https://www.change-pain.com/grt-change-pain-
portal/change_pain_home/chronic_pain/physician/physician_tools/picture_library/en_EN/312500026.jsp
MSF Clinical Guidelines and MSF protocols

3. WHAT IS PAIN?
An unpleasant sensory and emotional experience associated with actual
or potential tissue damage, or described in terms of such damage.IASP
DEFINITION 1979

4. PAIN ASSESSMENT:
● ONSET: MECHANISM OF INJURY OR ETIOLOGY OF PAIN, IF
IDENTIFIABLE
● LOCATION/DISTRIBUTION
● DURATION (ACUTE PAIN < 3 MONTHS,CHRONIC > 3
MONTHS) COURSE/TEMPORAL PATTERN
● CHARACTER AND QUALITY OF THE PAIN
● AGGRAVATING/PROVOKING FACTORS
● ALLEVIATING FACTORS AND ASSOCIATED SYMPTOMS
● SEVERITY: INTENSITY OR IMPACT ON FUNCTION, SLEEP,
MOOD
● BARRIERS TO PAIN ASSESSMENThttps://emedicine.medscape.com/article/1948069-overview#a3

5. PAIN SCALES:
Pain measurement tools may be categorized as either single-dimensional or
multidimensional scales. The measures require patient self-report on an aspect or
aspects of the pain.
Single-dimensional scales: SVS,VRS, NRS, VAS etc etc
Multidimensional scales: Mc Gill Pain Questionnaire, Brief Pain Inventory….etc etc

6. ....AND NEUROPATHIC PAIN? :0 DN4!!!!!!

7. TREATMENT OF NOCICEPTIVE PAIN
– Pain can only be treated correctly if it is correctly evaluated. The only person who can evaluate the
intensity of pain is the patient himself. The use of pain assessment scales is invaluable.
– The pain evaluation observations should be recorded in the patient chart in the same fashion as other vital
signs.
– Treatment of pain should be as prompt as possible.
– It is recommended to administer analgesics in advance when appropriate (e.g. before painful care
procedures).
– Analgesics should be prescribed and administered at fixed time intervals (not on demand).
– Oral forms should be used whenever possible.
– The combination of different analgesic drugs (multimodal analgesia) is advantageous.
– Start with an analgesic from the level presumed most effective: e.g., in the event of a fractured femur, start
with a Step 3 analgesic.
– The treatment and dose chosen are guided by the assessment of pain intensity, but also by the patient’s

8. By the ladder:
If pain occurs there should be prompt administration of
drugs
in the following order:
• non-opiods (e. g. acetaminophen)
• as necessary, mild opiods (e. g. codeine)
• then strong opiods (e. g. morphine or
hydromorphone) until the patient is free of pain
By the mouth:
The oral route is usually the preferred route for ease of
use in
a variety of care settings. However, it may not be
possible for
all patients (e.g. end-of-life, unconscious, swallowing
issues).
When the oral route is not feasible, the least invasive
route
should be considered (e.g. sub-lingual or sub-cutaneous
before intra-venous.).
By the clock:
To maintain freedom from pain, drugs should be given “by the
clock” or “around the clock” rather than only “on
demand” (i.e. PRN). This means they are given on a regularly
scheduled basis. The frequency will depend on whether it is a
long- or short-acting preparation
TREATMENT OF NOCICEPTIVE PAIN
Treatment depends on the type and intensity of the
pain. It may be both aetiological and symptomatic
if a treatable cause is identified. Treatment is
symptomatic only in other cases (no cause found,
non-curable disease).

9. Management of NeuropathicPain :
Neuropathic pain treatment should be multimodal, including pharmacological
treatment, rehabilitation and psychologic support
FIRST LINE TREATMENT
1. ANTIDEPRESSANTS
Amitriptyline
2. ANTICONSULSIVANTS
GABAPENTINE

10. ....IS IT TRUE OR
FALSE…??
❏ Self-report of pain is the single most reliable indicator of pain.
❏ The caregiver is the best judge of pain.
❏ Patients do no always verbalize their pain but express it is other ways
❏ Everyone experiences pain differently
❏ A person with pain will always have obvious signs such as moaning, abnormal vital
signs, or not eating.
❏ Addiction is common when opioid medications are prescribed.
❏ Pain medication should be given only after the patient develops pain.
❏ Pain is what a patient says it is.
❏ Pain is totally subjective.
❏ Patients do no always verbalize their pain but express it is other ways.
❏ Everyone experiences pain differently.
❏ One person’s report of severe pain may seem like almost nothing compared to
another.

11. Any Questions ??

12. Thank you