This document discusses pain management. It defines pain and describes the signs and symptoms of pain. It categorizes pain based on location, intensity, etiology, and duration. Acute pain is short-term while chronic pain lasts over 6 months. Treatment involves pharmacological interventions like NSAIDs, acetaminophen, and opioids as well as non-pharmacological methods such as heat/cold therapy, distraction, and massage. Proper pain assessment and determining the type and severity of pain guides treatment decisions.

1. PAIN MANAGEMENT
BY,
NADIRA SULTANA
PHARM.D (INTERN)
MTRIPS HKE’S GULBRGA

2. Pain
Defination:
Pain is an unpleasant sensory and
emotional experience associated with
actual and potential tissue damage

3. Important implication
 Pain is physical and emotional
experience, not all in the body or all in
the mind
 It is in response to actual or potential
tissue damage, so there may not be
abnormal lab or radiographic reports
despite real pain

4. Signs and symptoms of pain
 Increased heart rate
 Increased respiratory rate
 Peripheral vasoconstruction
 Pallor
 Elevated BP
 Increased blood glucose level
 Diaphoresis
 Dilated pupils

5. Types of pain
pain
Based on
location
Based on
intensity
Based on
etiology
Based on
duration

6. Based on duration
Acute Chronic
Chronic non cancer pain
Chronic cancer pain
Chronic episodic pain

7. Acute pain
 When pain lasts only through the expected
recovery period.
 Acute pain is protective, has an
identifiable cause, is of short duration and
has limited tissue damage and emotional
response.
 It eventually resolves with or without
treatment ,after an injury area heals

8.  Complete pain relief may not be
achievable, but reducing pain to a
tolerable level is realistic.
 Unrelieved acute pain can progress to
Chronic pain.

9. Chronic pain
 Is the pain that lasts longer than 6 months
and is constant or recurring with mild to
severe intensity .
 It does not always have an identifiable
cause.
Eg: arithritic pain, headache, peripheral
neuropathy.

10.  The possible unknown cause of chronic
pain, combined with unrelenting nature
and uncertainty of its duration , frustrates
a patient, frequently leading to
psychological depression.
 Associated symptoms of chronic pain:
fatigue, insomnia, anorexia, wieght loss,
hopelessness, anger.

11. Chronic non cancer pain
 That results due to non cancer disease
condition.

12. Chronic cancer pain
 Is the pain caused by tumour progression
and related pathological process,
involves procedures, toxicities of
treatment, infection and physical
limitations.

13. Chronic episodic pain
Pain that occurs sporadically over an
extended period of time.
Pain episodes last for hours, days or weeks
eg: migraine headaches

14. BASED ON LOCATION
 This is based on the site at which the pain is
located
eg: headache, cardiac pin, back pain, joint
pain, stomach pain,
 Reffered pain- pain due to problems in other
areas manifest in different body parts.
Eg: cardiac pain may be felt in the shoulders
or left arm, with or without chest pain

15. BASED ON INTENSITY
Mild pain
Moderate pain
Severe pain

16. Pain measurement scale

17. Based on intensity
 Mild pain: pain scale reading form 1-3 is
considered as mild pain
 Moderate pain: pain scale reading form
4 - 6 is considered as moderate pain
 Severe pain: pain scale reading from
7 – 10 is considered as severe pain

18. BASED ON ETIOLOGY
NOCICEPTIVE
PAIN
SOMATIC
PAIN
VISCERAL
PAIN
NEUROPATHIC
PAIN
PERIPHERA
L
CENTRAL

19. NOCICEPTIVE PAIN
 Is experienced when an intact, properly
functioning nervous system send signals
that tissue are damaged requiring attention
and proper care.
Eg: the pain experienced following a cut
or broken bone alerts the person to avoid
further damage until it is properly healed.
 Once stabilised or healed the pain goes
away

20. Somatic pain
 This is the pain that is originally from the
skin , muscles, bone, or connective
tissues.
eg: the sharp sensation of a paper cut or
aching of a sprained ankle

21. Visceral pain
 Is the pain that results from the activation
of nociceptors of the thoracic , pelvic, or
abnormal viscera (organs)
 Characterised by cramping, throbbing,
pressing or aching qualities.
Eg: labor pain, angina pectoris pr irritable
bowel

22. Neuropathic pain
 Neuropathic pain is associated with
damage or malfunctioing nerve due to
illness, injury or undertermined reason.
 Examples
1. Diabetic peripheral neuropathy
2. phantom limb pain
3. Spinal cord injury pain

23.  It is usually chronic.
 It is describe as burning, “electric shock”,
and/or tingling, dull and aching.
 Neuropathic pan to be difficult to treat.

24. There are 2 types of neuropathic
pain and classified as follows
 Peripheral neuropathic pain:
Due to damage of peripheral system
eg: phantom limb pain
 Central neuropathic pain:
Results from malfunctiong nerves in
the CNS
eg: spinal cord injury pain
post stroke pain

25. Pain assessment
 P recipatating/allveiating factors
what causes the pain? What aggravetes it? Has
medication or treatment worked in the past?
 Q uality of pain
Ask the patient to describe the pain using words
like....sharp, dull, stabbing, burning
 R adiation
Does pain exist in one location or radiate to other
areas?
 S everity
Have patient use a descriptive ,numeric or visual
scale to rate the severity of pain?
 T iming
Is the pain constant or intermittent, when did it begin?

26.  Assess the objective signs of pain
 Facial expression: facial grimacing,
frowning
 Vocalization: crying, moaning
 Body movements: guarding resistance to
moving

27. Grimacing face

28. Frowning face

29. Crying and moaning

30. Pain assessment tools
 There are various tools that are designed
to assess the level of pain
1. Verbal rating scale
2. Numeric rating scale
3. Wong Bakers faces rating scale

34. Management of pain
 Pain can be managed through
1. Pharmacological interventions
2. Non pharmacological interventions

35. Pharmacological intervations
 Mild pain
paracetamol or NSAIDS such as
ibuprofen or aspirin can be priscribed
 NSAIDS have an antiinflammatory
analgesic and antipyretic effects
 The antiinflammatory action relieves pain
by interfering with cyclooxygenase

36. Mild to moderate pain
 Paracetamol or NSAIDS and/or PCT in
combination product with weak opoid
such as hydrocodine, may provide greater
relief than their separate use.

37. Moderate to severe pain
 when treating moderate to severe pain ,the
type of pain , acute or chronic ,needs to be
considered
 The type of pin can result in different
medication being prescribed.
 Certain medication may work better for
acute pain ,other for chronic pain and
some may work equally on both.

38. NSAIDS
 NSAIDS produce the effects through
cyclooxygenase inhibition and are widely
used to relieve pain, with or without
inflammation in people with acute and
chronic pain..
 In single dose NSAIDS have analgesic
activity
 In regular higher dosage they have both long
acting analgesic and an antiinflammatory
action effects, which makes them particularly
useful for the treatment of continous or
regular associated with inflammation

39. 1. Salisylate →aspirin→325-600mgevery 4th
houlry
2. Para aminophenol → acetominophen → 325-
650mg (3-4 times a day)
3. Fenamates → mefanamic acid → 250-500mg
TDS
4. Propionic acid →
ibuprofen=400-800mg TDS
naproxen=250mg TDS
ketoprofen=50-100mg BD-TDS
flurbiprofen=50mg BD-QID
5. Diclofenac =50mg TDS, then BD oral, 75mg
deep i.m

40. Opioids analgesic
 Opiods bind to one of the four opiate
receptors: mu, kappa, sigma, delta
 Opiod can provide short intermedite or
long acting analgesia depending upon the
specific properties of the medication .
 Opiods may administer through IV, oral,
nasal mucosa, oral mucosa, rectal,
transdermally

41. Adjuvants
 Used for analgesic reason and for sedation
and reducing anxiety
 Examples
tri cyclic antidrepresants
antiepileptic
corticosteriods

42. Non pharmacological management
 For many individuals, use of non
pharmacologic methods enhance pain
reliefs
 These non pharmacological strategies are
often used combination with medication

43. No pharmacological therapies
 Heat and cold application
 Medication
 Distraction
 Imaginary
 TENS application
 Yoga
 Massage
 Accupunture
 Music therapy
 Herbal therapy-garlic, echinesea, ginseng