This document provides an overview of pain research and treatment approaches. It begins with classical anatomical, physiological, and psychological approaches to understanding pain. It then discusses the molecular and neural mechanisms of nociception and pain transmission from injury to the brain. Different classifications of pain such as nociceptive, neuropathic, and mixed types are presented. Current dimensions of pain including sensory, emotional, cognitive and social factors are reviewed. Treatment approaches like medications, nerve blocks, interventions, and complementary therapies are outlined. The mechanisms and uses of opioids, NSAIDs, and antidepressants for pain are explained.
1. The document discusses pain, defining it as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
2. Pain is always subjective and can be somatic, visceral, or neuropathic in nature. It can be acute or chronic, with chronic pain lasting over 3 months and having a large psycho-social component.
3. The gate control theory proposes that psychological factors can affect the experience of pain by opening and closing a "gate" in the spinal cord that modulates pain transmission.
This document discusses chronic pain management. It defines chronic pain as pain lasting over 3 months. It describes different types of pain such as somatic, visceral and neuropathic pain. It discusses various chronic pain conditions like fibromyalgia, complex regional pain syndrome, postherpetic neuralgia and diabetic neuropathy. It covers evaluation of chronic pain, pathophysiology of chronic pain, brain regions involved, and the multidimensional nature of chronic pain including physical, psychological and social factors. Finally, it discusses various management approaches for chronic pain including pharmacological, physical, psychological and invasive techniques.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a major unmet medical need, with chronic pain reducing quality of life similar to depression. Pain signals are transmitted through nociceptors and neurons from the peripheral to central nervous system. There are two main types of pain - fast pain conducted along thin myelinated fibers for sharp pain, and slow pain conducted along unmyelinated C fibers for dull pain. Acute pain serves a protective purpose while chronic pain persists independently of tissue damage. A variety of pharmacological and non-pharmacological options are used for pain relief.
The Shri Isari Velan Mission hospital provides comprehensive palliative care to patients with serious illnesses to help them live with comfort and dignity. Palliative care aims to enhance quality of life through effective symptom management and attention to patients' psychological, social, and spiritual needs. It can be delivered alongside life-prolonging care or as the main focus of care. The goal of palliative care is to improve quality of life for both patients and their families through a holistic, family-centered approach.
This document discusses pain, including definitions, types of pain, assessment, and treatment options. It defines pain and differentiates between acute and chronic pain. It classifies pain as somatic, visceral, or neuropathic based on pathophysiologic mechanisms. Assessment involves self-report scales as well as behavioral and physiologic measures. Treatment options depend on the type of pain and include opioids, NSAIDs, and adjuvant analgesics.
Chronic pain management involves comprehensive evaluation and treatment of pain. The IASP defines chronic pain as pain persisting beyond normal tissue healing time, usually 3 months. It impacts function and well-being. Treatment includes pharmacotherapy like opioids, nonopioids, and adjuvant analgesics. Opioids require careful patient selection, dosing, monitoring, and side effect management. Adjuvant analgesics like anticonvulsants and antidepressants are effective for neuropathic pain. A multimodal approach balances analgesia and side effects for optimal chronic pain treatment.
1. The document discusses pain, defining it as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
2. Pain is always subjective and can be somatic, visceral, or neuropathic in nature. It can be acute or chronic, with chronic pain lasting over 3 months and having a large psycho-social component.
3. The gate control theory proposes that psychological factors can affect the experience of pain by opening and closing a "gate" in the spinal cord that modulates pain transmission.
This document discusses chronic pain management. It defines chronic pain as pain lasting over 3 months. It describes different types of pain such as somatic, visceral and neuropathic pain. It discusses various chronic pain conditions like fibromyalgia, complex regional pain syndrome, postherpetic neuralgia and diabetic neuropathy. It covers evaluation of chronic pain, pathophysiology of chronic pain, brain regions involved, and the multidimensional nature of chronic pain including physical, psychological and social factors. Finally, it discusses various management approaches for chronic pain including pharmacological, physical, psychological and invasive techniques.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a major unmet medical need, with chronic pain reducing quality of life similar to depression. Pain signals are transmitted through nociceptors and neurons from the peripheral to central nervous system. There are two main types of pain - fast pain conducted along thin myelinated fibers for sharp pain, and slow pain conducted along unmyelinated C fibers for dull pain. Acute pain serves a protective purpose while chronic pain persists independently of tissue damage. A variety of pharmacological and non-pharmacological options are used for pain relief.
The Shri Isari Velan Mission hospital provides comprehensive palliative care to patients with serious illnesses to help them live with comfort and dignity. Palliative care aims to enhance quality of life through effective symptom management and attention to patients' psychological, social, and spiritual needs. It can be delivered alongside life-prolonging care or as the main focus of care. The goal of palliative care is to improve quality of life for both patients and their families through a holistic, family-centered approach.
This document discusses pain, including definitions, types of pain, assessment, and treatment options. It defines pain and differentiates between acute and chronic pain. It classifies pain as somatic, visceral, or neuropathic based on pathophysiologic mechanisms. Assessment involves self-report scales as well as behavioral and physiologic measures. Treatment options depend on the type of pain and include opioids, NSAIDs, and adjuvant analgesics.
Chronic pain management involves comprehensive evaluation and treatment of pain. The IASP defines chronic pain as pain persisting beyond normal tissue healing time, usually 3 months. It impacts function and well-being. Treatment includes pharmacotherapy like opioids, nonopioids, and adjuvant analgesics. Opioids require careful patient selection, dosing, monitoring, and side effect management. Adjuvant analgesics like anticonvulsants and antidepressants are effective for neuropathic pain. A multimodal approach balances analgesia and side effects for optimal chronic pain treatment.
Nociceptors are found in somatic structures like skin, muscle, connective tissue, bones and joints as well as visceral structures like organs and blood vessels. They detect and respond to potentially damaging stimuli to signal the presence of actual or threatened tissue damage.
The document discusses neuropathic pain, its etiology and treatment. It notes that chronic pain often has an unknown cause, persists after healing for at least 3 months, and requires treatment of both the underlying disease and pain disorder. It also categorizes neuropathies as focal like mononeuritis or entrapment, or diffuse like proximal or distal neuropathies affecting large or small fibers. Additionally, it states that many neuropathic pain patients continue suffering despite therapy and developing new rational treatments has been slow.
2015: Pain Management - A Practical and Functional Approach-LakkarajuSDGWEP
This document discusses chronic pain in older adults. It notes that chronic pain is common in older populations, affecting 25-50% of community-dwelling elders and 45-50% of nursing home residents. The pathophysiology of chronic pain can involve nerve sensitization, nerve damage, and inflammatory mediators. Treatment of chronic pain in older adults requires special considerations due to age-related changes in pharmacokinetics and pharmacodynamics. Non-pharmacological therapies and non-opioid medications are preferred, with opioids used cautiously at lower doses. Proper evaluation, treatment planning, and monitoring are important for safe and effective management of chronic pain in older patients.
This document discusses central sensitization (CS), including its recognition and implications for physiotherapy. It defines CS and reviews evidence that CS can be assessed using questionnaires, quantitative sensory testing, and factors like temporal summation. Management of CS may include education, cognitive approaches, TENS, exercise and medications targeting central pain processing. The document provides tips for physiotherapists in managing patients with CS, such as using appropriate pressures and treatment windows, addressing pain behaviors and beliefs, and taking a multidisciplinary approach.
This document provides an overview of pain, including its definition, classification, transmission pathways, and management. It begins with defining pain and discussing its incidence and epidemiology. Pain is then classified based on its source, duration, and transmission. The pathways of pain transmission from nociceptors to the central nervous system are explained. Finally, the document discusses pain assessment, management guidelines, and concludes with references.
Firmly palpates each of the 18 tender points with the thumb or finger, pressing into the muscle/fascia approximately 4 kg of pressure.
Patient: Rates pain on a scale of 0-3:
0 = No pain
1 = Mild pain (patient states "that's tender")
2 = Moderate pain (patient grimaces or withdraws)
3 = Severe pain (patient cries out)
*11/18 tender points must be rated 2/3 for diagnosis of FM per ACR criteria
Adapted from: Wolfe F, et al. Arthritis Rheum. 1990;33:160-172. 20
Diagnostic Criteria for FM
The document discusses neuropathic pain and its treatment. It defines neuropathic pain as pain initiated or caused by primary lesions or dysfunction in the nervous system. Some examples of neuropathic pain given are postherpetic neuralgia, diabetic peripheral neuropathy, and post-surgical neuropathy. The document outlines approaches to diagnosing neuropathic pain, including listening to the patient's description of their pain, looking for sensory abnormalities, and locating the region of pain to a neuroanatomical area. It discusses treating neuropathic pain with topical medications, systemic medications like anticonvulsants, antidepressants and opioids.
Pain and its treatment in psychiatric practice (2) (1)Adonis Sfera, MD
This document discusses chronic pain from both a historical and medical perspective. It defines acute versus chronic pain and nociceptive versus neuropathic pain. It describes how chronic pain involves central sensitization and can become a way of life. The relationship between pain and conditions like depression is complex. The medicalization of chronic pain through drugs like aspirin changed views of chronic pain. Currently, there are controversies around balancing treating pain while reducing risks of prescription drug abuse and addiction. Serotonin-norepinephrine reuptake inhibitors have been approved to treat some chronic pain disorders.
This document provides an overview of pain and pain pathways. It defines pain, discusses the history of pain theories, and describes the different types of pain receptors and neural pathways involved in pain perception and modulation. Specifically, it outlines fast and slow pain pathways conducted by myelinated and unmyelinated fibers, discusses peripheral and central mechanisms of injury-induced pain, and classification of pain including somatic and visceral pain.
Conclusions:
74% of patients discharge home with moderate to severe pain --> with or without treatment before
ED patients should receive proper pain management, avoiding delays such as those related to diagnostic testing or consultation
In order to further improve patient care we must now apply our knowledge regarding acute and chronic pain treatment base on pharmacology of the drugs
Ongoing research in the area of ED patient pain management conducted and an algorythm or clinical guidelines in this area should be developed
Effective physician and patient educational strategies should be developed regarding pain management, including the use of pain therapy adjuncts and how to minimize pain after disposition from the ED
This document discusses pain control in operative dentistry. It begins with definitions of pain from various sources and discusses changing concepts of pain, including recognizing pain as more of an experience than just a sensation. It describes the somatosensory system and neural pathways of pain. It then covers causes of orofacial pain, diagnosis and assessment of pain, factors influencing pain, and differential diagnosis. Methods to control pain are discussed.
The document discusses molecular mechanisms of pain and summarizes recent research from the Bogomoletz Institute of Physiology in Kiev, Ukraine. It covers classification of pain, measurements used to study pain, sensory pathways involved in pain transmission, ion channels and receptors implicated in pain such as ASICs, P2X receptors, T-type calcium channels and TRPV1. Recent findings from studies of knockout mice and modulators of ion channels suggest these molecular targets hold promise for developing new pain treatments.
This document discusses pain pathophysiology and management. It describes how the pain sensory system detects and responds to tissue damage to protect the body. Pain signals are transmitted via nociceptors in the peripheral nervous system and ascend through the spinal cord and brainstem to the thalamus and cortex. Central pathways can modulate pain transmission both inhibitively and facilitatively. Neuropathic pain can occur when the peripheral or central nervous system is damaged and causes abnormal pain signaling and hypersensitivity. Effective pain management requires understanding these complex physiological mechanisms.
This document discusses chronic pain management and focuses on neuropathic pain. It defines neuropathic pain as pain arising from damage or disease affecting the somatosensory nervous system. Neuropathic pain is estimated to affect 3.3-8.2% of the population and results from structural and molecular changes in the pain pathway. Common causes include diabetes, shingles, spinal injuries and strokes. The mechanisms of neuropathic pain involve increased neuronal excitability and hyperactivity of NMDA receptors. Symptoms vary based on the affected nerve fibers but include burning sensations, pins and needles, and electric shock-like pain. Treatment involves a stepped approach starting with gabapentin, tricyclic antidepressants or SNRIs and may include opioids if needed.
12.04.08(a): Pathogenesis and Treatment of FibromyalgiaOpen.Michigan
Slideshow is from the University of Michigan Medical School's M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
1. The document discusses the pathophysiology of pain, which involves transduction, transmission, perception, and modulation of pain signals in the body.
2. Pain signals are transmitted from nociceptors via the peripheral nervous system to the spinal cord and brain. Various neurotransmitters are involved at different stages of transmission.
3. Pain perception is influenced by both physical and psychological factors and can be modulated in the brain using various pharmacological and non-pharmacological treatments.
Physiotherapy interventions for children with CRPS type 1, including desensitization, heat, exercises, weight bearing, TENS, hydrotherapy, and sensory stimulation, showed improvements in symptoms for the majority of patients in case studies and reviews. However, the evidence is limited due to the small number of studies and heterogeneous nature of the data. Larger, higher quality studies are still needed to provide definitive treatment recommendations for this population.
This document contains information from multiple studies on opioid use and prescribing trends:
- A national survey from 1997-2007 found increases in opioid prescribing rates, with the highest rates (over 80 prescriptions per 100 persons) seen in those aged 61-80.
- Cohort and longitudinal studies from multiple countries showed increases in defined daily doses of opioids like morphine, codeine, and pethidine from the late 1980s through early 2000s.
- Studies analyzed trends in prescribing of different classes of pain medications like opioids, NSAIDs, and acetaminophen alone or in combination.
The document discusses the differences between the biomedical industry and traditional businesses. It notes that the biomedical industry has traditionally been stakeholder-oriented and not-for-profit focused on intellectual labor, while businesses are stockholder-oriented and profit-driven, focusing on turning assets into commodities. Bridging this gap between the two approaches poses challenges to developing the biomedical industry.
Nociceptors are found in somatic structures like skin, muscle, connective tissue, bones and joints as well as visceral structures like organs and blood vessels. They detect and respond to potentially damaging stimuli to signal the presence of actual or threatened tissue damage.
The document discusses neuropathic pain, its etiology and treatment. It notes that chronic pain often has an unknown cause, persists after healing for at least 3 months, and requires treatment of both the underlying disease and pain disorder. It also categorizes neuropathies as focal like mononeuritis or entrapment, or diffuse like proximal or distal neuropathies affecting large or small fibers. Additionally, it states that many neuropathic pain patients continue suffering despite therapy and developing new rational treatments has been slow.
2015: Pain Management - A Practical and Functional Approach-LakkarajuSDGWEP
This document discusses chronic pain in older adults. It notes that chronic pain is common in older populations, affecting 25-50% of community-dwelling elders and 45-50% of nursing home residents. The pathophysiology of chronic pain can involve nerve sensitization, nerve damage, and inflammatory mediators. Treatment of chronic pain in older adults requires special considerations due to age-related changes in pharmacokinetics and pharmacodynamics. Non-pharmacological therapies and non-opioid medications are preferred, with opioids used cautiously at lower doses. Proper evaluation, treatment planning, and monitoring are important for safe and effective management of chronic pain in older patients.
This document discusses central sensitization (CS), including its recognition and implications for physiotherapy. It defines CS and reviews evidence that CS can be assessed using questionnaires, quantitative sensory testing, and factors like temporal summation. Management of CS may include education, cognitive approaches, TENS, exercise and medications targeting central pain processing. The document provides tips for physiotherapists in managing patients with CS, such as using appropriate pressures and treatment windows, addressing pain behaviors and beliefs, and taking a multidisciplinary approach.
This document provides an overview of pain, including its definition, classification, transmission pathways, and management. It begins with defining pain and discussing its incidence and epidemiology. Pain is then classified based on its source, duration, and transmission. The pathways of pain transmission from nociceptors to the central nervous system are explained. Finally, the document discusses pain assessment, management guidelines, and concludes with references.
Firmly palpates each of the 18 tender points with the thumb or finger, pressing into the muscle/fascia approximately 4 kg of pressure.
Patient: Rates pain on a scale of 0-3:
0 = No pain
1 = Mild pain (patient states "that's tender")
2 = Moderate pain (patient grimaces or withdraws)
3 = Severe pain (patient cries out)
*11/18 tender points must be rated 2/3 for diagnosis of FM per ACR criteria
Adapted from: Wolfe F, et al. Arthritis Rheum. 1990;33:160-172. 20
Diagnostic Criteria for FM
The document discusses neuropathic pain and its treatment. It defines neuropathic pain as pain initiated or caused by primary lesions or dysfunction in the nervous system. Some examples of neuropathic pain given are postherpetic neuralgia, diabetic peripheral neuropathy, and post-surgical neuropathy. The document outlines approaches to diagnosing neuropathic pain, including listening to the patient's description of their pain, looking for sensory abnormalities, and locating the region of pain to a neuroanatomical area. It discusses treating neuropathic pain with topical medications, systemic medications like anticonvulsants, antidepressants and opioids.
Pain and its treatment in psychiatric practice (2) (1)Adonis Sfera, MD
This document discusses chronic pain from both a historical and medical perspective. It defines acute versus chronic pain and nociceptive versus neuropathic pain. It describes how chronic pain involves central sensitization and can become a way of life. The relationship between pain and conditions like depression is complex. The medicalization of chronic pain through drugs like aspirin changed views of chronic pain. Currently, there are controversies around balancing treating pain while reducing risks of prescription drug abuse and addiction. Serotonin-norepinephrine reuptake inhibitors have been approved to treat some chronic pain disorders.
This document provides an overview of pain and pain pathways. It defines pain, discusses the history of pain theories, and describes the different types of pain receptors and neural pathways involved in pain perception and modulation. Specifically, it outlines fast and slow pain pathways conducted by myelinated and unmyelinated fibers, discusses peripheral and central mechanisms of injury-induced pain, and classification of pain including somatic and visceral pain.
Conclusions:
74% of patients discharge home with moderate to severe pain --> with or without treatment before
ED patients should receive proper pain management, avoiding delays such as those related to diagnostic testing or consultation
In order to further improve patient care we must now apply our knowledge regarding acute and chronic pain treatment base on pharmacology of the drugs
Ongoing research in the area of ED patient pain management conducted and an algorythm or clinical guidelines in this area should be developed
Effective physician and patient educational strategies should be developed regarding pain management, including the use of pain therapy adjuncts and how to minimize pain after disposition from the ED
This document discusses pain control in operative dentistry. It begins with definitions of pain from various sources and discusses changing concepts of pain, including recognizing pain as more of an experience than just a sensation. It describes the somatosensory system and neural pathways of pain. It then covers causes of orofacial pain, diagnosis and assessment of pain, factors influencing pain, and differential diagnosis. Methods to control pain are discussed.
The document discusses molecular mechanisms of pain and summarizes recent research from the Bogomoletz Institute of Physiology in Kiev, Ukraine. It covers classification of pain, measurements used to study pain, sensory pathways involved in pain transmission, ion channels and receptors implicated in pain such as ASICs, P2X receptors, T-type calcium channels and TRPV1. Recent findings from studies of knockout mice and modulators of ion channels suggest these molecular targets hold promise for developing new pain treatments.
This document discusses pain pathophysiology and management. It describes how the pain sensory system detects and responds to tissue damage to protect the body. Pain signals are transmitted via nociceptors in the peripheral nervous system and ascend through the spinal cord and brainstem to the thalamus and cortex. Central pathways can modulate pain transmission both inhibitively and facilitatively. Neuropathic pain can occur when the peripheral or central nervous system is damaged and causes abnormal pain signaling and hypersensitivity. Effective pain management requires understanding these complex physiological mechanisms.
This document discusses chronic pain management and focuses on neuropathic pain. It defines neuropathic pain as pain arising from damage or disease affecting the somatosensory nervous system. Neuropathic pain is estimated to affect 3.3-8.2% of the population and results from structural and molecular changes in the pain pathway. Common causes include diabetes, shingles, spinal injuries and strokes. The mechanisms of neuropathic pain involve increased neuronal excitability and hyperactivity of NMDA receptors. Symptoms vary based on the affected nerve fibers but include burning sensations, pins and needles, and electric shock-like pain. Treatment involves a stepped approach starting with gabapentin, tricyclic antidepressants or SNRIs and may include opioids if needed.
12.04.08(a): Pathogenesis and Treatment of FibromyalgiaOpen.Michigan
Slideshow is from the University of Michigan Medical School's M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
1. The document discusses the pathophysiology of pain, which involves transduction, transmission, perception, and modulation of pain signals in the body.
2. Pain signals are transmitted from nociceptors via the peripheral nervous system to the spinal cord and brain. Various neurotransmitters are involved at different stages of transmission.
3. Pain perception is influenced by both physical and psychological factors and can be modulated in the brain using various pharmacological and non-pharmacological treatments.
Physiotherapy interventions for children with CRPS type 1, including desensitization, heat, exercises, weight bearing, TENS, hydrotherapy, and sensory stimulation, showed improvements in symptoms for the majority of patients in case studies and reviews. However, the evidence is limited due to the small number of studies and heterogeneous nature of the data. Larger, higher quality studies are still needed to provide definitive treatment recommendations for this population.
This document contains information from multiple studies on opioid use and prescribing trends:
- A national survey from 1997-2007 found increases in opioid prescribing rates, with the highest rates (over 80 prescriptions per 100 persons) seen in those aged 61-80.
- Cohort and longitudinal studies from multiple countries showed increases in defined daily doses of opioids like morphine, codeine, and pethidine from the late 1980s through early 2000s.
- Studies analyzed trends in prescribing of different classes of pain medications like opioids, NSAIDs, and acetaminophen alone or in combination.
The document discusses the differences between the biomedical industry and traditional businesses. It notes that the biomedical industry has traditionally been stakeholder-oriented and not-for-profit focused on intellectual labor, while businesses are stockholder-oriented and profit-driven, focusing on turning assets into commodities. Bridging this gap between the two approaches poses challenges to developing the biomedical industry.
論文架構與書寫
I read a very inspiring structure, sand glass model, to edit into a short presentation slide for you. It guides students how to condense from erratic thoughts into focused hypothesis. Hope this is useful while your are suffering from manuscript preparation.
Fibromyalgia is a disease, which is difficult to diagnose. These slides include ACR criteria 1990 and 2010 with Wide spread pain index(WPI) and Symptom severity score(SSS)
The document discusses key performance indicators related to physical fitness and health over time. It shows graphs comparing metrics like average blood glucose and cholesterol levels between the United States and world from 2001-2010, with both seeing improvements. Other graphs show how measures like liver enzymes have decreased from 2003-2010, suggesting exercise may play a role. The document advocates for regular exercise, noting recommendations of 30 minutes daily at moderate intensity to maintain health and reduce disease risk factors.
Neuromuscular blockers can be classified as either competitive antagonists that bind reversibly to nicotinic receptors (e.g. vecuronium) or depolarizing blockers that cause sustained depolarization of the motor end plate (e.g. succinylcholine). Competitive blockers have a longer duration of action and are not antagonized by cholinesterase inhibitors, while depolarizing blockers have a very short duration due to hydrolysis by plasma cholinesterase and their effects can be reversed. Neuromuscular blockers are used adjuvantly in surgical anesthesia to facilitate procedures by providing muscle relaxation.
This document discusses central sensitization, a condition where the central nervous system amplifies sensory processing, resulting in hypersensitivity and chronic pain. It begins by explaining how acute pain becomes chronic pain due to central sensitization. It then describes the mechanisms of central sensitization, including wind-up in the spinal cord, impaired descending pain inhibition, and changes in the brain. It discusses how central sensitization can be assessed through measures like conditioned pain modulation, exercise-induced analgesia, and hypersensitivity questionnaires. The document provides criteria for identifying central sensitization in musculoskeletal pain patients and signs and symptoms of central sensitization. It concludes by discussing treatment implications when central sensitization is present.
我們關注都市空氣中懸浮微粒的資訊,讓大家關注每一口呼吸的空氣。
Living in this big city, we are concerned about all the information, even if it is as tiny as an air particle, so that everyone else can grasp all of it.
This document summarizes three non-depolarizing muscle relaxants: atracurium, vecuronium, and pancuronium. It describes the chemical nature, mechanism of action, kinetics including metabolism and excretion, effects, problems/toxicity, and special considerations for each drug. Atracurium is metabolized primarily through Hofmann elimination and NSE hydrolysis. Vecuronium undergoes deacetylation in the liver to active metabolites. Pancuronium undergoes up to 45% hepatic metabolism with subsequent biliary excretion. All three drugs act as competitive antagonists at nicotinic receptors in the neuromuscular junction.
This document discusses the autonomic nervous system and various drugs that act on it. It covers the sympathetic and parasympathetic systems, neurotransmitters like epinephrine, norepinephrine, and acetylcholine. It also summarizes drug classes like adrenergic agonists and antagonists, cholinergic drugs, and treatments for conditions like Parkinson's disease. Side effects of various autonomic drugs are also mentioned.
This document summarizes different types of antidepressant medications, including their classifications, mechanisms of action, and side effects. Tricyclic antidepressants (TCAs) work by inhibiting the reuptake of norepinephrine and serotonin. Common side effects include dry mouth and cardiac issues. Monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme, increasing levels of neurotransmitters, but require dietary restrictions. Selective serotonin reuptake inhibitors (SSRIs) specifically target serotonin reuptake with fewer side effects than TCAs. Newer atypical antidepressants have varied mechanisms of action targeting serotonin, norepinephrine, or their receptors.
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by inhibiting the reuptake of serotonin. SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. They are highly selective for serotonin reuptake compared to other neurotransmitters. While SSRIs share the common mechanism of inhibiting serotonin reuptake, they differ in their pharmacokinetic properties such as half-life, metabolic pathways, and drug interaction potential. Adverse effects of SSRIs include nausea, sexual dysfunction, headaches, and weight changes.
This document discusses pain management in palliative care. It defines types of pain including neuropathic and nociceptive pain. It describes approaches to pain control including thorough assessment, investigations if needed, pharmacological and non-pharmacological treatments, and ongoing reassessment. Types of opioids, routes of administration, switching between opioids, and managing breakthrough pain are covered. Adjuvant analgesics and their uses are also summarized.
This document provides an overview of pharmacology related to analgesic, antipyretic, and anti-inflammatory drugs. It discusses the nervous system and pain pathways, different types of pain including nociceptive and neuropathic pain, common pain-relieving medications like NSAIDs, acetaminophen, opioids, and neuropathic agents. It covers administration, patient education, and monitoring of pain treatment. Key points include the mechanisms and side effects of different drug classes, considerations for special populations, and the importance of the nurse's role in advocating for adequate pain relief.
This document discusses key concepts in post-operative pain management. It defines types of pain and outlines consequences of poorly managed acute post-operative pain such as increased risk of chronic pain, medical complications, and decreased patient satisfaction. The document reviews various analgesic agents including acetaminophen, NSAIDs, opioids, local anesthetics, and the benefits of a multimodal approach. Regional anesthesia techniques like peripheral nerve blocks and epidural analgesia are presented as effective options for post-operative pain control.
- The document provides an overview of pain therapy and clinical aspects presented by Dr. L. S. Patil.
- It discusses the goals of pain therapy, approaches to patients with pain including classification, measurement scales, and examination.
- Types of pain like nociceptive and neuropathic pain are defined. Analgesic treatments like NSAIDs, opioids, and the WHO pain ladder are explained.
- Management of chronic pain, use of TCAs, anticonvulsants, and opioids are covered. The role of a multidisciplinary team and various modalities are highlighted. Pain in palliative care is also addressed.
This document provides an overview of drugs used in the nervous system, including analgesics, sedatives, and hypnotics. It discusses the classification, mechanism of action, dosages, indications, contraindications, side effects, and nursing responsibilities for various classes of drugs like NSAIDs, opioids, benzodiazepines, and barbiturates. The key classes covered are analgesics like NSAIDs for pain and fever relief, sedatives-hypnotics including benzodiazepines and barbiturates for inducing sleep or calm, and their use, effects, and monitoring by nurses.
This document provides an overview of drugs used in the nervous system, including analgesics, sedatives, and hypnotics. It discusses the classification, mechanism of action, examples, dosages, indications, contraindications, adverse effects, interactions, and nursing responsibilities for various drug categories. Key points covered include non-opioid analgesics like NSAIDs; opioid analgesics; benzodiazepines used as sedatives and hypnotics; and barbiturates which are now less commonly used. Nursing priorities are monitoring for side effects, ensuring safe administration, teaching patients about proper usage, and watching for drug interactions.
Slides are prepared as per INC Syllabus Unit IX Drugs used in nervous system and it is most benefited for B sc Nursing students and faculty of the subject
This document discusses various drugs used in the nervous system. It begins by outlining the topics to be covered, including analgesics, anesthetics, cholinergics, anticholinergics, antidepressants, and CNS stimulants. It then provides details on analgesics like NSAIDs, opioids, and barbiturates. It explains their mechanisms of action, examples and dosages, indications, contraindications, adverse effects, drug interactions, and nursing responsibilities. Sedatives and hypnotics are also summarized, focusing on benzodiazepines and barbiturates. Overall, the document concisely reviews many commonly used drugs for the nervous system.
Current therapies in management of neuropathic painpurnendu mandal
1. Neuropathic pain arises from damage or disease affecting the somatosensory system and is described as symptoms like burning, shooting, or tingling.
2. It is challenging to diagnose due to complex mechanisms and diverse symptoms, but assessment involves comprehensive history and use of scales.
3. Current therapies target mechanisms like ectopic nerve activity and increased spinal cord excitability using classes of drugs like gabapentinoids, TCAs, and opioids. Non-pharmacological treatments can also help manage neuropathic pain.
1362576458 new look at painful neuropathydfsimedia
This document discusses insights into painful neuropathy in diabetes. It notes that chronic neuropathic pain affects 20% of diabetics with over 10 years duration. The frequency of chronic painful neuropathy is similar in type 1 and type 2 diabetes. Several treatment options are discussed including tricyclic antidepressants, anticonvulsants like gabapentin and pregabalin, alpha-lipoic acid, capsaicin cream, and physical therapies like TENS and PENS. Tight glucose control is also emphasized as important for managing painful neuropathy.
The correct response is to c) call the anesthesiologist for pain assessment. If the epidural is not providing adequate pain relief over time, the anesthesiologist needs to be notified to assess the epidural and make adjustments if needed. Comforting the patient without addressing the increasing pain is not appropriate care.
The document provides information on clinical analgesia including objectives, quiz questions, and details on pain mechanisms and treatment. It discusses non-opioid analgesics like acetaminophen and NSAIDs as well as adjuvant analgesics including antidepressants, anticonvulsants, corticosteroids, and muscle relaxants. The document also provides dosing information for various analgesics.
Neuropathic pain strategies to improve clinical outcomewebzforu
This document discusses strategies for improving outcomes for patients with neuropathic pain. It begins by describing common conditions associated with neuropathic pain such as diabetes and shingles. It then discusses diagnostic approaches and distinguishing characteristics of neuropathic pain. Key points covered include the pathogenesis of neuropathic pain and new treatment options that modulate underlying mechanisms. Major forms of neuropathic pain like post-herpetic neuralgia and diabetic neuropathy are examined in depth. The document concludes by outlining a stepwise approach to managing neuropathic pain.
This document discusses pain management and treatment modalities. It defines pain and describes types of pain such as acute and chronic. It also discusses peripheral nerve fibers involved in pain perception. The major categories of pain are nociceptive and neuropathic pain. Pain assessment instruments include single-dimension scales like VAS and multidimensional scales. Principles of treatment include reduction of pain through various methods and rehabilitation. Treatment modalities discussed include analgesic agents like opioids, adjuvants, and non-pharmacological methods. Specific analgesics like paracetamol, NSAIDs, opioids, tramadol, and local anesthesia are also covered.
This document provides an overview of chronic pain management. It defines chronic pain and discusses its classification, mechanisms, evaluation, and multimodal treatment approaches. Chronic pain is defined as pain persisting beyond tissue healing, usually 3-6 months. Treatment involves a multimodal approach including drug therapies, psychological therapies, rehabilitation, anesthesiological techniques, neurostimulation, lifestyle changes, and complementary therapies. Specific treatment modalities discussed include various pharmacological interventions, cognitive-behavioral therapy, biofeedback, and spinal cord stimulation.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
This document discusses chronic pain management in older people. It defines chronic pain as lasting more than 3-6 months and negatively impacting well-being. Chronic pain is classified as nociceptive, inflammatory, neuropathic, or mixed. Risk factors include genetic susceptibility, preceding pain, psychosocial factors, age, and sex. Treatment involves pharmacological options like NSAIDs, opioids, antidepressants, anticonvulsants, and non-pharmacological options like education, exercise, and cognitive behavioral therapy. Specific recommendations are provided for chronic pain management in older adults.
The document discusses various types of analgesics, including opioids and non-opioid analgesics. It provides details on morphine, including its mechanism of action, uses, side effects, and toxicity. It also covers non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and acetaminophen. NSAIDs work by inhibiting prostaglandin synthesis and reducing inflammation. The document outlines their mechanisms, classifications, uses, and potential side effects.
This document discusses neuropathic pain and its treatment. It begins by defining pain and describing the differences between nociceptive and neuropathic pain. Neuropathic pain arises from abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system. The document then discusses the pathogenesis and physiology of pain perception. It provides examples of conditions that can cause central or peripheral neuropathic pain such as diabetes, shingles, spinal cord injury and stroke. The document reviews potential treatment options for neuropathic pain which include medications, physical therapies, and surgery. It provides details on several pharmacological treatments for neuropathic pain including capsaicin, lidocaine, various antidepressants, anticonvulsants, gabapentin, pregabalin, tramadol
21. Molecular marker of pain
ms sec min hour day week month year
AMPA
NMDA,
Sub-P, CGRP
Ca, NO, PKC
apoptosis ???
Neuronal Sprouting
dynorphin
NPY, galanin
c-fos
Kao & Sun, Chinese J Pain, 2003.
pErk
30. Mixed Type
Caused by a
combination of both
primary injury or
secondary effects
Clincal Pain
Nociceptive
Pain
Caused by activity in
neural pathways in
response to potentially
tissue-damaging stimuli
Neuropathic
Pain
Initiated or caused by
primary lesion or
dysfunction in the nervous
system
Postoperative
pain
Cancer pain
Osteoporosis
Arthritis
Back pain
Postherpetic
neuralgia
Neuropathic
spinal stenosis
Cancer pain
Myofascial pain
Central post-
stroke pain
Phantom pain
Trigeminal
neuralgia
Polyneuropathy (eg,diabetic,
chemotherapy)
75. 孫維仁
COX-2
NSAID on COX-1/2
COX-1
N-terminal
Carboxylic
group
of NSAID
forms
“salt bridge”
with
Arginine
at 120
C-terminal
containing
active sites
Arachidonic
Acid
NSAID
(flurbiprofen)
phenyl group
binds to
hydrophobic
channel
N-terminal
Carboxylic
group
of NSAID
forms
“salt
bridge”
with
Arginine
at 120
C-terminal
containing
active sites
Arachidonic
Acid
NSAID
(flurbiprofen)
phenyl group
binds to
hydrophobic
channel
Kurumbail et al. Nature. 1996; 384: 644-648
76. 孫維仁
Specific COX-2 Inhibitor
- “Side Pocket”
Hydrophilic
“side pocket”
N-terminal
C-terminal
containing
active sites
Arg 513,
Hist 90 – forms
hydrogen bonds with
oxygen in sulfonamide
side chain
Specific COX-2
inhibitor – phenyl
group binds to
hydrophobic channel
Arachidonic
Acid
Arg 120
Kurumbail et al. Nature 1996; 384: 644-648
78. Antidepressants in
Multiple mechanisms of action
RCTs and meta-analyses demonstrate benefit of
amitriptyline, nortriptyline, desipramine
Variable onset of analgesia
Independent of antidepressant activity
Improvements in insomnia, anxiety, depression
*Not approved by
FDA for this use.
79. Tricyclic Antidepressants
for Neuropathic Pain Disorders
Start at 10-25 mg at bedtime
increase every few days as tolerated to a target dose of 50 mg
if no effect at 2 wk, continue to increase
may need ≥150 mg
Can split dose to reduce side effects
Expect partial effect
use multiple agents
Consider preprescription cardiac evaluation