Pain management

Chief complaint at emergencies:

The main and common reason for patients to seek healthcare and be admitted to hospitals.

It is your body warning that something is wrong, that you might be in danger or you might be doing something wrong to prevent you from damage.

Pain is a very individual experience depending on the severity or the type of pain a person is having, that can be physical or mental, it is the sensation that «It hurts», the perception of unpleasant sensation with the associated feeling of discomfort and/or suffering.

Pain can be a chronic pain mild or intense and lasts a long time or acute pain intense and short:


What is chronic pain :

It is the pain that lasts more than six months, described as shooting, burning, aching, or electrical.

It can be:

  • Mild or excruciating.
  • Episodic or continuous.
  • Merely inconvenient .
  • Totally incapacitating.


The symptoms of chronic pain include:

  • Feeling of discomfort.
  • Soreness.
  • Tightness.
  • Stiffness.
  • Fatigue.
  • Sleeplessness.
  • Withdrawal from activity and increased need to rest.
  • Weakened immune system.
  • Changes in mood including hopelessness, fear,depression, irritability, anxiety, and stress.
  • Disability.


Causes of Chronic pain :

Some causes can be traced to a specific injury other no but mainly these are the main causes:

  • Lowback pain.
  • Arthritis, especiallyosteoarthritis.
  • Headache.
  • Multiple sclerosis.
  • Fibromyalgia.
  • Shingles.
  • Nerve damage(neuropathy).

What is acute pain :

It is a normal predicted physiologic response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness.

It results from activation of the pain receptors (nociceptors) at the site of tissue damage.

Causes of acute pain :

This type of pain generally accompanies surgery, traumatic injury, tissue damage, and inflammatory processes, it is typically self-limited and resolves over days to weeks, but it can persist for 3 months or longer as healing occurs.

Symptoms of Acute pain :

Acute pain can activate the sympathetic branch of the autonomic nervous system and produce such responses:

  • Hypertension
  • Tachycardia
  • Diaphoresis
  • Shallow respiration
  • Restlessness
  • Facial grimacing
  • Guarding behavior
  • Pallor
  • Pupil dilation
  • Etc.

Types of pains :

  • Nociceptive Pain: stimulate receptors that sense temperature (hot/cold), vibration, stretch, and chemicals released from damaged cells. It can be somatic felt on the skin, muscle, joints, bones and ligaments or visceral felt in the internal organs and main body cavities, thorax (lungs and heart), abdomen (bowels, spleen, liver and kidneys), and the pelvis (ovaries, bladder, and the womb).
  • Non-Nociceptive: Pain that comes from the nervous systemit can be Neuropathic felt within the nervous system itself or Sympathetic it is on the level of our blood flow to our skin and muscles, perspiration (sweating) by the skin, it occurs generally after a fracture or a soft tissue injury of the limbs.
  • Referred Pain : felt either next to, or at a distance from the origin of an injuryfor instance  a heart attack, even though the affected area is the heart, the pain is sometimes felt around the shoulders, back and neck, rather than in the chest.

Pain Assessment:

A subjective identification of all pains if the person is able to report his pain includes:

  • The site, quality, and radiation of pain.
  • What factors aggravate and relieve the pain.
  • When the pain occurs throughout the day.
  • What impact the pain has on the person’s function.
  • What impact the pain has on the person’s mood.
  • The sufferers’ understanding of their pain.

To completely assess and manage patient’s acute pain, healthcare providers need:

  • Knowledge
  • Interviewing techniques
  • Physical assessment skills.
  • When possible, obtain self-report.
  • Look for possible pathologies, procedures, or other causes of pain.
  • Observe for behaviors that may indicate the presence of pain.
  • Obtain input from people who know the patient and the patient’s usual behaviors and responses to pain.
  • Use an analgesic trial and observe for changes in behavior.

An observational pain measures report is used in case the person is unable to report his own pain.

Pain Treatments:

Treatment to get rid or reduce pain depending on the type of pain and what is causing it .

Opioid Analgesics strongest pain killer for severe pain  commonly used after surgery, for cancer, broken bones, burns, and various other situations.

Nonopioid analgesics are used generally for mild to moderate pain. They are not addictive and their pain-relieving effects do not dwindle over time.

NSAIDs (nonsteroidal anti-inflammatory drugs) obtained OTC (over-the-counter) or as a prescription medication effective for headaches, muscle aches, fever, and minor pains.

  • Traditional NSAIDsthey do carry a risk of side-effects, such as stomach upset and gastrointestinal bleeding.
  • COX-2 inhibitors- these also reduce pain and inflammation, designed to have fewer stomach and gastrointestinal side-effects.
  • Salicylates- these include aspirin which continues to be a popular medication for many doctors and patients. Long term high dosage usage of aspirin carries with it a significant risk of serious undesirable side effects, such as kidney problems and gastrointestinal bleeding.

Nonacetylated salicylate is designed to have fewer side effects than aspirin. Some doctors may prescribe nonacetylated salicylate if they feel aspirin is too risky for their patient.

Any type of pain treatment should be prescribed and monitored by a doctor.

Pain Management :  It is a mental and physical treatment:

Chronic and acute pain management :

A combination of pain management treatments and techniques is often the most successful way to manage chronic pain:

  • Medications to manage pain :

–       NSAIDs (non-steroidal anti-inflammatory drugs), including ibuprofen, naproxen, and aspirin

–       Acetaminophen (Tylenol)

–       Antidepressants, which can improve sleep and alleviate pain

–       Anti-seizure medications, which can be effective in treating pain related to nerve damage or injury

–       Steroids, like dexamethasone and prednisone, to alleviate inflammation and pain

  • Physical therapy
  • Cognitive-behavioral therapy
  • Exercise.
  • Manipulation and massage.
  • Meditation.
  • Relaxation techniques
  • Heat and cold therapy.
  • TENS (Transcutaneous electrical nerve stimulation) therapy.
  • Visual imagery, as simple as picturing a peaceful scene, for example.
  • Biofeedback, which teaches control over muscle tension, temperature, heart rate and more.
  • Blocking nerves from pain at particular points.

Today’s pain specialists have sophisticated new treatments from effective drugs to implants and electrical stimulation to provide chronic pain relief:

When pain becomes of dangerous signification:

  • Severe Chest Pain
  • Lasting Abdominal pain
  • Changes in headaches patterns
  • Difficult or painful swallowing

Many other symptoms that are not pain are indicative of a health danger such as bleeding, blacking out, changes in skin colors, trouble breathing, changes in mental functioning, fever with vomiting and diarrhea.

Undertreatment of Pain  :

Approximately 80 percent of the world population has either no or insufficient access to treatment for moderate to severe pain.

Every year tens of millions of people around the world, including around four million cancer patients and 0.8 million HIV/AIDS patients at the end of their lives suffer from such pain without treatment.

Reasons for undertreatment :

  • Provider perceptions: inadequate training, for elderly the misconception that pain is a normal part of aging.
  • Opioid concerns: personal biases or fear of prescription drug abuse.
  • Systems issues: Clinical, Cultural, Societal, Religious, philosophical, political attitudes, including acceptance of torture.

Pain management in an ethical issue it is a legal right and human right and failure to provide pain management should be considered a sentenced professional misconduct.

Transform the way that people with pain get the care they need and deserve.

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