Pain management , pain medication , pain control or algiatry , is a branch of medicine that uses an interdisciplinary approach to easing suffering and improve the quality of life of those living with chronic pain A typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurses. The team can also include mental health specialists and other massage therapists. Pain sometimes disappears as soon as the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (sometimes) anxiolytics. Effective management for chronic (long-term) pain, however, often requires the coordinated effort of the management team.
Medications treat injury and pathology to support and speed healing; and treating troublesome symptoms such as pain to reduce suffering during treatment and healing. When injury or painful pathology is resistant to treatment and continues, when the pain continues after injury or pathology has healed, and when medical science can not identify the cause of pain, the task of treatment is to relieve suffering. Treatment approaches for chronic pain include pharmacological measures, such as analgesics, antidepressants and anticonvulsants, intervention procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological actions, such as biofeedback and cognitive behavioral therapy.
Video Pain management
Usage
Pain can have many causes and there are many possible treatments for it. In the nursing profession, a common definition of pain is any problem, that is "whatever happens to the person experiencing it, that is whenever the experienced person says it". Different types of pain management overcome various types of pain.
Pain management involves patient communication about pain problems. To determine the problem of pain, the health care provider may ask a question like this:
- How intense is the pain?
- How's the pain?
- Where is the pain?
- What, if anything, makes the pain less?
- When did the pain begin?
After asking such questions, the health care provider will have a picture of the pain. Pain management will then be used to overcome the pain.
Maps Pain management
Adverse effects
There are many types of pain management, and each has their own benefits, disadvantages, and limits.
A common difficulty in pain management is communication. People who experience pain may have difficulty recognizing or describing how they feel and how strong it is. Healthcare providers and patients may have difficulty communicating with each other about how pain responds to treatment. There is a continuing risk in many types of pain management for patients to take less effective treatments than necessary or causing difficulties and other side effects. Some treatments for pain can be harmful if overused. Pain management goals for patients and their health care providers to identify the number of treatments that overcome pain but not too much care.
Another problem with pain management is pain is the body's natural way to communicate a problem. Pain must be solved because the body regenerates itself with time and pain management. Sometimes pain management includes problems, and patients may be less aware that they need care for deeper problems.
Physical Approach
Pharmaceuticals and physical rehabilitation
Physical treatment and rehabilitation use a variety of physical techniques such as thermal agents and electrotherapy, as well as therapeutic and behavioral therapy exercises, alone or together with conventional intervention and pharmacotherapy techniques to treat pain, usually as part of an interdisciplinary or multidisciplinary program.
TENS
Transcutaneous electrical nerve stimulation has been found to be ineffective for lower back pain, however, it may be helpful with diabetic neuropathy. Although there has not been sufficient evidence-based research on acute sensory TENS, chronic conditions are efficacious in relieving pain. TENS is indicated for any chronic musculoskeletal condition under the pain gate control theory. Basically, the gate control theory states that sensory fibers carry their signals faster than pain fibers, and thus make their way to the dorsal root ganglion of the spine (gate) much faster. This in turn causes the pain signals to be blocked by the sensory TENS signal. This theory explains why rubbing a broken leg eases the pain. A study conducted by Oncel M and team compared the efficacy of TENS with nonsteroidal anti-inflammatory drugs (NSAIDs, Naproxen sodium) in patients who had patients with minor minor fractures without complications. The researchers found that TENS therapy given twice daily for 3 days resulted in significant pain reduction and was found to be more effective than NSAIDs or placebo.
Acupuncture
Acupuncture involves insertion and manipulation of needles to certain points on the body to relieve pain or for therapeutic purposes. Analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 at the British Medical Journal, can not quantify the difference in effects on real, false and no acupuncture pain.
Acupuncture is trusted by its followers to restore the balance of energy in the body through the stimulation of energy channels called meridians. It is believed that acupuncture therapy reduces pain signals through the production of endorphins known as natural pain relievers. Clinical studies show that acupuncture can reduce joint pain and therapy can be effective in reducing the pain caused by knee osteoarthritis.
Light therapy
Research has not found evidence that light therapy such as low-level laser therapy is an effective therapy to relieve back pain.
Interventional procedure
Interventional procedures - usually used for chronic back pain - include epidural steroid injections, facet joint injections, neurolytic blocks, spinal cord stimulants and implanted intrathecal drug delivery systems.
Radiofrequency pulses, neuromodulation, direct recognition of drugs and nerve ablation can be used to target tissue structures and organs/systems responsible for persistent nociceptive or nociceptors of the structures involved as a source of chronic pain.
An intrathecal pump is used to send small amounts of the drug directly to the spinal fluid. This is similar to the epidural infusion used in labor and postoperatively. The main difference is that it is more common for drugs to be sent to the spinal fluid (intrathecal) than the epidural, and the pump can be fully grown under the skin. Interestingly, it is suggested that this approach allows for smaller doses of the drug to be sent directly to the site of action, with fewer systemic side effects, thereby questionable therapeutically due to the fact that three major opioid receptors; especially [? -? -, and? (Mu-, Kappa-, and Delta-respectively) are limited in their anatomical locations. 3 major receptors are found to be dominant in the brain, CNS and gastrointestinal tract.
Spinal cord stimulation is an implantable medical device that creates electrical impulses and applying them near the dorsal surface of the spinal cord provides a sensation of paresthesia ("tingling") that alters the perception of pain by the patient.
A small number of patients, especially those suffering from severe cancer-induced sickness, can benefit from surgical treatments such as cordotomy.
Psychological Approach
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) for pain helps patients with pain to understand the relationship between a person's physiology (eg, muscle pain and tension), thoughts, emotions, and behavior. The main goal in treatment is cognitive restructuring to encourage a helpful mindset, targeting the activation of healthy activity behaviors such as regular exercise and pacing. Lifestyle changes are also trained to improve sleep patterns and to develop better coping skills for other pain and stress using a variety of techniques (eg, relaxation, diaphragm breathing, and even biofeedback).
Studies have demonstrated the usefulness of cognitive behavioral therapy in the management of chronic back pain, resulting in a significant reduction in physical and psychosocial disability. A study published in the January 2012 edition of Archives of Internal Medicine found CBT was significantly more effective than standard care in treating people with body-wide pain, such as fibromyalgia. Evidence for the usefulness of CBT in the management of chronic adult pain is generally poorly understood, partly due to the dubious proliferation of quality techniques, and poor reporting quality in clinical trials. The essential contents of individual intervention have not been isolated and important contextual elements, such as therapeutic training and the development of treatment manuals, have not been determined. The highly variable nature of the resulting data makes a useful systematic review and meta-analysis in the field very difficult.
In 2012, a systematic review of randomized controlled trials (RCTs) evaluated the clinical efficacy of psychological therapy for management of chronic adult pain (excluding headaches). There is no evidence that behavioral therapy (BT) is effective in reducing this type of pain, but BT may be useful for improving a person's mood immediately after treatment. This increase seems small, and short-term duration. CBT may have a small positive short-term effect on pain soon after treatment. CBT may also have a small effect on disability reduction and potential calamities that may be associated with chronic adult pain. This benefit does not seem to last long after therapy. CBT can contribute to an improved mood of adults with chronic pain, and it is likely that these benefits can be maintained for longer periods of time.
For children and adolescents, an RCT review evaluating the effectiveness of psychological therapy for chronic and recurrent pain management found that psychological treatments are effective in relieving pain when people under the age of 18 experience headaches. This beneficial effect can be maintained for at least three months after therapy. Psychological treatments can also improve pain control for children or adolescents who experience pain unrelated to headaches. It is not known whether psychological therapy improves the mood of children or adolescents and the potential disability associated with their chronic pain.
Hypnosis
A 2007 review of 13 studies found evidence of hypnotic efficacy in pain reduction in some conditions, although the number of patients enrolled in the study was small, raising the issue of strength to detect group differences, and most not having credible controls for placebo and/or hope. The authors conclude that "although the findings provide support for the general application of hypnosis in the treatment of chronic pain, more research will be needed to fully determine the effects of hypnosis for various conditions of chronic pain."
Hypnosis has reduced the pain of some dangerous medical procedures in children and adolescents, and in clinical trials dealing with other patient groups has significantly reduced pain compared to no treatment or some other non-hypnotic intervention. However, no studies comparing hypnosis with placebo are conclusive, so pain reduction may be due to patient expectations ("placebo effect"). The effect of self hypnosis on chronic pain is roughly proportional to progressive muscle relaxation.
Awareness meditation
A meta-analysis study using techniques centered around the concept of attention, concluded, "The findings suggest that MBI decreases pain intensity for chronic pain patients."
Drugs
The World Health Organization (WHO) recommends Mild pain
Paracetamol (acetaminophen), or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Mild to moderate pain
Paracetamol, NSAIDs and/or paracetamol in combination products with weak opioids such as tramadol, may provide greater relief than a separate use. Also the combination of opioids with acetaminophen can often be used such as Percocet, Vicodin, or Norco.
Moderate to severe pain
When treating moderate to severe pain, this type of pain, acute or chronic, needs to be considered. This type of pain can cause various prescribed medications. Certain medications can work better for acute pain, others for chronic pain, and some may work well in both. The acute pain medication is for rapid onset of pain such as from trauma inflicted or to treat post-operative pain. Chronic pain medication is to reduce the pain that lasts a long time and sustained.
Morphine is a gold standard compared to all narcotics. The semi-synthetic derivatives of morphine such as hydromorphone (Dilaudid), oxymorphone (Numorphan, Opana), nicomorphine (Vilan), hydromorphinol and others vary in ways such as duration of action, side effects profiles and potential miligramme. Fentanyl has fewer benefits of histamine release and thus fewer side effects. This can also be provided via convenient transdermal patches for chronic pain management. In addition to Intrathecal and Sublimaze injecting patches, the FDA has approved various immediate release fentanyl products for breakthrough cancer pain (Actiq/OTFC/Fentora/Onsolis/Subsys/Lazanda/Abstral). Oxycodone is used in America and Europe to relieve serious chronic pain; the slow-release formula is primarily known as OxyContin, and short-acting tablets, capsules, syrups and ampoules are available making it perfect for pain or acute breakthrough pain. Diamorphine, methadone and buprenorphine are used less frequently. Petidin, known in North America as meperidine, is not recommended for pain management due to its low potency, short duration of work, and toxicity associated with repeated use. Pentazocine, dextromoramide and dipipanone are also not recommended in new patients except for acute pain where other analgesics are not tolerated or inappropriate, for pharmacological and abuse reasons. In some strong synthetic states such as pyriteramide and ketobemidone are used for severe pain, and tapentadol is a new agent introduced in the last decade.
For moderate pain, tramadol, codeine, dihydrocodeine, and hydrocodone use, with nicocodeine, ethylmorphine and propoxyphene and dextropropoxyphene less common.
Other types of drugs can be used to help opioids fight certain types of pain, for example, amitriptyline is prescribed for chronic muscular pain in the arms, legs, neck and lower back with opiates, or sometimes without it and/or with NSAIDs.
Although opiates are often used in the management of chronic pain, high doses are associated with an increased risk of opioid overdose.
Opioid
From the Food and Drug Administration website: "According to the National Institutes of Health, studies have shown that the proper use of opioid analgesic drugs (taken exactly as prescribed) is safe, can manage pain effectively, and rarely lead to addiction."
Opioid drugs may provide short, medium or long work analgesia depending on the specific nature of the drug and whether it is formulated as an extended drug release. Opioid drugs may be administered orally, by injection, via the nasal or renal mucosa, rectal, transdermal, intravenous, epidural and intrathecal. In chronic pain conditions that are responsive to a combination of long-acting opioids (OxyContin, MS Contin, Opana ER, Exalgo and Methadone) or extended release drugs are often prescribed in conjunction with shorter-acting drugs (oxycodone, morphine or hydromorphone) for breakthrough pain , or exacerbations.
Most opioid treatments used by patients outside of health care settings are oral (tablets, capsules or fluids), but suppositories and skin patches may be prescribed. Opioid injections are rarely needed for patients with chronic pain.
Although opioids are a strong analgesic, they do not provide complete analgesia regardless of whether the pain is acute or chronic. Opioids are efficacious analgesics in chronic malignant pain and are very effective in the management of non-malignant pain. However, there are associated side effects, especially during commencement or dose changes. When opioids are used for prolonged periods of drug tolerance, chemical dependence, diversion and addiction may occur.
Clinical guidelines for prescribing opioids for chronic pain have been excluded by the American Pain Society and the American Academy of Pain Medicine. Included in these guidelines is the importance of assessing patients for the risk of substance abuse, abuse, or addiction; personal or family history of substance abuse is the strongest predictor of the deviant behavior of drug abuse. Doctors prescribing opioids should integrate these treatments with any psychotherapy interventions that the patient may receive. The guidelines also recommend monitoring not only pain but also the level of function and achievement of therapeutic goals. The prescribing doctor should be suspicious of abuse when a patient reports pain reduction but does not have accompanying improvements in function or progress in achieving the identified objectives.
Opioid long-acting yang umum digunakan dan senyawa induknya:
- OxyContin (oxycodone)
- Hydromorph Contin (hydromorphone)
- MS Contin (morfin)
- M-Eslon (morfin)
- Exalgo (hydromorphone)
- Opana ER (oxymorphone)
- Duragesic (fentanyl)
- Nucynta ER (tapentadol)
- Metadol/Methadose (metadon) *
- Hysingla ER (bitartrat hidrokarbon)
- Zohydro ER (hidrokodon bikarbonat)
Methadone can be used either for the treatment of opioid/detoxification addiction when taken once daily or as a pain medication which is usually given every 12 hour interval or 8 hours of dosing.
Nonsteroidal anti-inflammatory drugs
The other major analgesic group is the nonsteroidal anti-inflammatory drug (NSAID). Acetaminophen/paracetamol is not always included in this class of drugs. However, acetaminophen may be administered as a single drug or in combination with other analgesics (both NSAIDs and opioids). Prescribed NSAIDs such as ketoprofen and piroxicam have limited benefits for chronic pain disorder and long-term use is associated with significant adverse effects. Selective use of NSAIDs designated as selective COX-2 inhibitors has significant cardiovascular and cerebrovascular risk that has limited their use.
Antidepressants and antiepileptic drugs
Some antidepressant and antiepileptic drugs are used in the management of chronic pain and act primarily in the pain path of the central nervous system, although the peripheral mechanism has been associated as well. This mechanism varies and is generally more effective in neuropathic pain disorders as well as complex regional pain syndromes.
Cannabinoids
Chronic pain is one of the most commonly cited reasons for the use of medical marijuana. A 2012 Canadian survey of participants in their medical marijuana program found that 84% of respondents reported using medical marijuana for pain management.
Evidence of the effect of relieving medical marijuana pain is generally conclusive. Detailed in a 1999 report by the Institute of Medicine, "evidence available from animal and human studies suggests that cannabinoids can have substantial analgesic effects". In a review study 2013 published in Fundamental & amp; Clinical pharmacology, various studies cited in showing that cannabinoids show comparable effectiveness for opioids in models of acute pain and even greater effectiveness in chronic pain models. Other analgesics
Other drugs are often used to help analgesics combat various types of pain, and part of the overall pain experience, and hence are called adjuvant analgesic drugs. Gabapentin - anti-epilepsy - not only gives effect to neuropathic pain, but can potentiate opiates. Although it may not be prescribed as such, other drugs such as Tagamet (cimetidine) and even simple grapefruit juice can also potentiate opiates, by inhibiting the CYP450 enzyme in the liver, thereby slowing drug metabolism. In addition, orphenadrine, cyclobenzaprine, trazodone and other drugs with anticholinergic properties are useful in conjunction with opioids for neuropathic pain. Orphenadrine and cyclobenzaprine are also muscle relaxants, and are therefore very useful in painful musculoskeletal conditions. Clonidine has found use as an analgesic for this same purpose, and all of the mentioned drugs potentiate the overall opioid effect.
Society and culture
Undertreatment
The non-pain treatment is the absence of pain management therapy for someone who is in pain when treatment is indicated.
Consensus in evidence-based medicine and recommendations from medical specialist organizations establish guidelines that determine the treatment for the pain that healthcare providers must offer. For various social reasons, people in pain may not seek or may not be able to access care for their pain. At the same time, healthcare providers may not provide the treatment recommended by the authorities.
In children
Acute pain is common in children and adolescents as a result of injury, illness, or necessary medical procedures. Chronic pain is present in about 15-25% of children and adolescents, and may be caused by an underlying disease, such as sickle cell anemia, cystic fibrosis, rheumatoid arthritis, or cancer or by functional disorders such as migraine, fibromyalgia, or complex. regional pain.
- Rating
Assessment of pain in children is often challenging due to limitations in their developmental level, cognitive abilities, or previous pain experience. Doctors should observe the physiological and behavioral cues shown by the child to make judgments. Self-reporting, if possible, is the most accurate measure of pain; the pain scale of self-reports developed for children involves matching the intensity of their pain for other children's facial images, such as the Oucher Scale, pointing to a facial scheme that shows different levels of pain, or indicating the location of pain on the body line. Questionnaires for older children and adolescents included the Varni-Thompson Pediatric Pain Questionnaire (PPQ) and the Child Comprehensive Pain Questionnaire, which is often used for individuals with chronic or persistent pain.
- Nonpharmacologic
Carers can provide nonpharmacological treatments for children and adolescents because of their small and cost-effective risks compared to pharmacological treatments. Nonpharmacological interventions vary by age and developmental factors. Physical interventions to relieve pain in infants include nipple, shake, or sucrose through the pacifier, while for children and adolescents including hot or cold applications, massage, or acupuncture. Cognitive behavioral therapy (CBT) aims to reduce emotional stress and improve the daily functioning of school-aged children and adolescents with pain through a focus on changing the relationship between their thoughts and emotions in addition to teaching them adaptive coping strategies. Integrated interventions in CBT include relaxation techniques, awareness, biofeedback, and acceptance (in cases of chronic pain). Many therapists will hold sessions for caregivers to provide them with effective management strategies.
- Pharmacology
Acetaminophen, a nonsteroidal anti-inflammatory agent, and opioid analgesics are commonly used to treat acute or chronic pain symptoms in children and adolescents, but pediatricians should be consulted before administering any medication.
Professional certification
Practitioners of pain management come from all areas of medicine. In addition to medical practitioners, the pain management team may often benefit from input from pharmacists, physiotherapists, clinical psychologists and occupational therapists, among others. Together a multidisciplinary team can help create the appropriate treatment package for the patient.
Source of the article : Wikipedia
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