acute pain - christchurch hospital · pain & suffering ‘an unpleasant sensory & emotional...
TRANSCRIPT
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NETP: 2015
Acute Pain
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Mr. & Mrs. Munster were the first television couple
to be seen sleeping together in the same bed
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Pain & Suffering
‘an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage’
International Association for the Study of Pain
Suffering involves the experience of pain & additionally the complex context that the individuals pain occurs within, the multiple issues that must be endured
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The Science of Nociception
Nociceptors = detect noxious stimuli
- heat
- irritating chemicals
- intense mechanical stimulation
Signals are transmitted to the spinal cord via first order neurons - A-delta δ fibers
- C-fibers
Second order neurons cross over & continue upwards in the anterolateral spinothalamic tracts to the thalamus & the cerebral cortex
The message is perceived as pain
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Physiologic Pain
Rapidly perceived
nontraumatic
discomfort
of very short
duration
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Nociceptive Pain
Noxious perception resulting from
cellular changes
following surgical,
traumatic or
disease
related
injuries
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Neuropathic Pain
Pain initiated or
caused by a
pathological lesion
or dysfunction
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Pain Assessment
The single most
reliable indicator
of the existence
and intensity of
pain and any
resultant distress
is the patients
self report
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If you want to
know if your
patient is in pain
- ask them and
believe what
they say
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Fears & Misconceptions
Fear of addiction
Fear of tolerance
Fear of respiratory depression
Underestimation of pain
Misunderstanding opioid legal regulations
Reserving stronger analgesia
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Pain Management a
Fundamental Human Right
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Evidence identifies pain assessment is effective when:
- it is regularly presented
- uses a patient-matched tool
- acknowledges variables
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Treatment of Acute Pain
Multimodal approach
Analgesic algorithms
Assessment:
- frequent & regular
- pain on rest & movement
- sedation score
- respiratory rate
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Consequences of Undertreated Pain
Suffering
Complications
Death
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Adult Opioid Policy
The right dose is enough
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Individualised Analgesia
Regimens
Dose
Route
Dose interval
Opioid naïve patient
Opioid experienced patient
Addiction
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OPIOID NAÏVE OR
OPIOID EXPERIENCED
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Opioids, Opiates & Narcotics
Both naturally occurring & synthetic molecules
that produce effects by action at opioid
receptors
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Opioid Analgesia
Foundational drug in the management of moderate severe nociceptive pain
Morphine
Pethidine
Fentanyl
Alfentanil
Methadone
Oxycodone
Codiene
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Naloxone
Opioid antagonist that competitively
displaces opioid analgesia from their receptor
sites, thus reversing their effects
Used to reverse adverse effects or overdose
effects of opioid agonists
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Adjuncts
Tramadol
Cox2 Parecoxib
Paracetamol
Magnesium
Ketamine
Gabapentin
Clonidine
Amitriptyline
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Tolerance
Drug tolerance is the
gradual decrease in
the effectiveness of a
drug given repeatedly
over a period of time:
if tolerance develops
higher doses are
required to achieve
the same effect
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Dependence
Manifested by withdrawal symptoms after the
drug is suddenly removed
May be psychological as well as physiological
Symptoms include stress response signs;
sweating, nausea, vomiting, tremors, mood
changes
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Addiction
Addiction involves inseparable biological
and behavioral components. It is the
quintessential
biobehavioral
disorder
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