Pain is a common and often undertreated problem. Effective pain management is important as pain can have serious psychological and physical effects. It is also a basic human right. There are challenges to effective pain management, including conflicting views between patients and healthcare providers about reported pain levels and needed treatment. Proper use of the WHO analgesic ladder and comprehensive pain management regimens tailored to individual patients can help ensure patients' pain is adequately treated.

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