Title: Management of Pain

Authos: Sachin Kagane, Merlyn Gomes, Priyanka Thakur

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i5.34

Abstract

Pain management is improving steadily over the past few years, but training and professional education is still lacking in many professions. Untreated or undertreated acute pain could have detrimental effects on the patient in terms of comfort and recovery from trauma or surgery. Acute undertreated pain can decrease a patient's vascular perfusion, suppress the immune system, increase oxygen demand and possibly risk increased incidence of venous thrombosis. Although acute postoperative pain needs to be managed aggressively, patients are most vulnerable during this period for developing adverse effects, and therefore, patient assessment and careful drug therapy evaluation are necessary processes in therapeutic planning. Acute pain management requires careful and thorough initial assessment and in addition to frequent dosage adjustments follow-up reassessment is also needed and managing analgesic induced side effects. Analgesic selection and dosing must be based on the patient's past and recent analgesic exposure. There is no single acute pain management regimen that is suitable for all patients. Analgesics must be tailored to the individual patient.

Key words: Nociceptive pain, Neuropathic pain, Verbal rating scale, Numerical rating scale, Visual analogue scale.

References

    

1.      IASP Sub-committee on Taxonomy. Pain terms: a list with definitions and notes on usage. Pain 1980; 8: 249-52.

2.      Black RG.The Chronic Pain Syndrome. Surgical Clinics of North America. 1975; 55: 999-1011.

3.      Carr DB, Goudas LC. Acute pain. Lancet. 1999;353:20512058. Abstract

4.      Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. Pain Manag Nurs. 2008;9(1 Suppl):1121.

5.      Rosenfeld BA, Faraday N, Campbell D, Dise K, Bell W, Goldschmidt P. Hemostatic effects of stress hormone infusion. Anesthesiology. 1994;81:11161126.Abstract

6.      Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am. 2005;23:2136.

7.      Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain 1996;66:195205.

8.      Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534540. Abstract

9.      Gupta A, Daigle S, Mojica J, Hurley RW. Patient perception of pain care in hospitals in the United States. J Pain Res. 2009;2:157164

10.  Roth W, Kling J, GockelI I. Dissatisfaction with postoperative pain management a prospective analysis of 1071 patients. Acute Pain. 2005;7:7583

11.  Bonica JJ. Definitions and taxonomy of pain. In: Bonica JJ. Ed. The Management of Pain 2 edn. Philadelphia: Lea & Febiger 1990: 18-27.

12.  Pasero C, McCaffery M. Pain Assessment and Pharmacologic Management. St. Louis, Mo: Mosby; 2011

13.  Arnstein P. Clinical Coach for Effective Pain Management. Philadelphia, Pa: F.A. Davis Company; 2010

14.  Sipos Cox D, Karapas ET. Taxonomy for pain management nursing. In: St. Marie B, ed. Core Curriculum for Pain Management Nursing. 2nd ed. Dubuque, Ia: Kendall Hunt Professional; 2010.

15.  Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth. 2013 Jul;111(1):19–25.

16.  Zwakhalen SMG, van Dongen KAJ, Hamers JPH, Abu-Saad HH. Pain assessment in intellectually disabled people: non-verbal indicators. J Adv Nurs. 2004 Feb;45(3):236–45.

17.  Herr KA, Mobily PR. Comparison of selected pain assessment tools for use with the elderly. Appl Nurs Res. 1993 Feb;6(1):39–46.

18.  Wallenstein SL, Heidrich G, Kaiko R, Houde RW. Clinical evaluation of mild analgesics: the measurement of clinical pain. Br J Clin Pharmacol. 1980 Oct;10 Suppl 2:319S – 327S.

19.  Rowbotham DJ and Macintyre PE (Eds). Clinical Pain Management: Acute Pain. London: Arnold Publisher 2003.

20.  Miller J, Moore K, Schofield A, Ng’andu N. A study of discomfort and confusion among elderly surgical patients. Orthop Nurs. 1996 Dec;15(6):27–34.

21.  Deyo et al DK et. Development of sensitivity to facial expression of pain. - PubMed - NCBI [Internet]. [cited 2016 Jan 22]. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/14715384

22.  Turk, D.C., Melzack, R. (1992) Handbook of Pain Assessment. New York, NY: Guilford Press.

23.  Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004 Jan;10(1):6–13.

24.  American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 6th ed. Glenview, Ill: American Pain Society; 2008.

25.  Pasero C. Aroundtheclock (ATC) dosing of analgesics. J Perianesth Nurs. 2010;25:3639.Abstract

26.  Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83:1125.Abstract

27.  Eksterowicz N, QuinlanCowell A, Vanderveer B, Menez J. Acute pain management. In: St. Marie B, ed. Core Curriculum for Pain Management Nursing. 2nd ed. Dubuque, Ia: Kendall Hunt Professional; 2010:343.

28.  Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute post operative pain. Curr Opin Anaesthesiol 2009; 22:588593.

29.  White PF, Kehlet H, Liu S. Perioperative analgesia: what do we still know? Anesth Analg. 2009;108:13641367.

30.  American Society of Anesthesiologists Task Force on Acute Pain Management Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2004;100:15731581. Abstract

31.  Hutchison RW, Tucker WF Jr, Gilder R. A comparison of a fentanyl, morphine, and hydromorphone patientcontrolled intravenous delivery for acute postoperative analgesia: a multicenter study of opioidinduced adverse reactions. Hosp Pharm. 2006;41:659663.

32.  D'Arcy Y. One opioid does not fit all. Nurse Pract. 2007;32:78.

33.  Somogyi AA, Barratt DT, Coller JK. Pharmacogenetics of opioids. Clin Pharmacol Ther. 2007;81:429444. Abstract

34.  Lötsch J, Geisslinger G. Current evidence for genetic modulation of the response to analgesics. Pain. 2006;121:15. Abstract

35.  Trescot AM, Datta S, Lee M, Hansen H.. Opioid pharmacology. Pain Physician. 2008;11: S133S153..Abstract

36.  Krenzischek DA, Dunwoody CJ, Polomano RC, Rathmell JP. Pharmacotherapy for acute pain: implications for practice. J Perianesth Nurs. 2008;23:S28S42. Abstract

37.  Hader CF. Epidural analgesia in the critically ill. Nursing 2007 Critical Care. 2007;2:2030

Corresponding Author

Sachin Kagane

Senior Resident, Department of Pharmacology,

D Y Patil University School of Medicine, Navi- Mumbai, Maharashtra, India