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DR - Muhammad Aasam Maan: Consultant Pain Specialist

pain management

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Muhammad Aasim Maan
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148 views23 pages

DR - Muhammad Aasam Maan: Consultant Pain Specialist

pain management

Uploaded by

Muhammad Aasim Maan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Dr.

MUHAMMAD AASAM MAAN


MBBS,DPHA,FCPS
M.Sc.PAIN MEDICINE
CONSULTANT PAIN SPECIALIST
INCHARGE INTENSIVE CARE UNIT
ALLIED HOSPITAL,FAISALABAD
PAIN

Is an unpleasant sensory and


emotional experience associated with
actual and potential tissue damage, or
described in terms of such damage.
(American Pain
Society[APS],2003;Gordon,2002)
IMPORTANT
IMPLICATIONS

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.
Pain is described in terms of such damage.
LOCATION

Classifications of pain based on where it is


in the body may be useful in determining
the clients underlying problems or needs.
Complicating the categorization of pan by
location is the fact that some pains
radiate(spread or extend) to other areas.
DURATION

Acute pain- lasts only through the expected recovery


period whether it has a sudden or slow onset and
regardless of intensity.
Chronic pain- is prolonged, usually recurring o
persisting over 6 months or longer, and interferes
with functioning.
Mild to severe, constant or recurring without an
anticipated or predictable end and a duration of
greater than 6 months. (Ackley&Ladwig, 2006)
INTENSITY
Classified using a standard 0(no pain) to
10 (worst possible pain) scale.
Mild pain- rating of 1-3
Moderate pain- rating of 4-6
Severe pain- reaching 7-10 and is
associated with worst outcome.
ETIOLOGY

Physiological pain- experienced when an intact,


properly functioning nervous system sends signals that
tissue are damaged, requiring attention and proper
care.
Somatic pain- originates in the skin, muscles, bones
or connective tissue with sharp sensation of a paper
cut or aching of sprained ankle.
Visceral pain- poorly located and may have
cramping, throbbing, pressing, or aching quality.
Often associated with feeling sick.
Neuropathic pain- experienced by people with
damaged or malfunctioning nerves.
Peripheral neuropathic pain- follows damage
and/or sensitization f peripheral nerves.
Central neuropathic pain- results from
malfunctioning nerves in Central nervous
system.
Sympathetically maintained pain- occurs
occasionally when abnormal connections
between pain fibers and the sympathetic
nervous system perpetuate problems with both
the pain and sympathetically controlled
function.
Pain interferes with sleep, affects
appetite and lowers quality of life for
clients and their family members.
Natural response is to stop activity,
tense muscles, and withdraw from
the pain-provoking activities which
reduced mobility that may produce
muscle atrophy and painful spasm.
Uncontrolled pain impairs
immune function, which slows
healing and increase susceptibility
to infections and dermal ulcers.
This short, shallow breathing that
accompanies pain produces
atelectasis , lowers circulating
oxygen and increase cardiac load.
Barriers to Pain Management
Source Issues
Care Providers
incl. Physicians" Inadequate education in
pain management.
" Fears and myths about
pain and opioid analgesics.
Inadequate follow-up
processes.
Barriers to Pain Management
Patients and " Myths about the
Families inevitability of pain.
" Culture and religious
issues.
" Social and economic
factors.
System " A lack of standards in pain
control.
" A lack of palliative care
and
other specialized pain
management resources.
Components of
Comprehensive Care
1. Deal with Total Pain
! Physical, psychological, family, & social
components.
2. Educate patient and family to ensure
active participation in the pain
management plan.
! through repeated conversations & supportive
literature that is comprehensive &
comprehensible.
Components of Comprehensive Care

3. Be flexible in your approach. Template or


algorithmic approaches or guidelines need
to be tempered by individual patient
factors and by physician reflective
experience.
4. Use an interdisciplinary team effectively.
5. Develop standards of pain control that
may
effectively prevent unnecessary suffering.
! It is of clinical importance to try and
distinguish the types or components of a
patients pain since this assessment has
clinical management implications in the
use of analgesics, adjuvant drugs and
other analgesic modalities.
Pain Assessment Tools

! Verbal Analogue Scales.

! Visual Analogue Scales.

! The Faces Scale.


Basic Principles in Managing Pain

1. Educate patient and family.


2. Investigate wisely and effectively.
3. Do not delay treatment. Treat the pain
immediately.
4. Use a pain diary and objective measures of
pain.
5. Have a good understanding of the
pharmacology
of analgesics and adjuvant medications.
6. Give medication orally whenever possible.
7. Give medication regularly according to
its analgesic duration of effect.

8. Prescribe an analgesic that matches


the severity of the pain.

9. Always prescribe a breakthrough dose.


10. Titrate the dose upwards on a daily
basis using immediate-release forms of
analgesics until pain is mostly relieved or
intractable adverse effects occur.
11. Always consider adjuvant modalities
and medication in every patient.
12. Take a preventive approach to avoid
the adverse effects of the medication.
Evaluation
1. Pain outcomes must be evaluated in
each patient.
2. The outcomes to be evaluated include:
# Pain level.
# Adverse effects of medication.
# Patient and family knowledge of and
participation in pain management.
# Development of other pains.
3. The care plan should specifically
state a monitoring plan
implemented by the
interdisciplinary team.

4. Access to care providers should


be on a24-hour per day basis.
TAKE HOME MESSAGE

Effective treatment requires a clear


understanding of the type of pain ,
pharmacology,potential and social
impact, and adverse effects associated
with each of the treatment prescribed,
and how these may vary from patient to
patient.

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