Iranian Pain Society
IASP Chapter
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Iranian Pain Society IASP Chapter
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This section edited by : M . Sharify , MD
I. Physiology and psychology of acute pain
Psychological aspects of acute pain
1. Preoperative anxiety , catastrophising , neuroticism and depression are associated with higher postoperative pain intensity . 2. Preoperative anxiety and depression are associated with an increased number of patient-controlled analgesia ( PCA ) demands and dissatisfaction with PCA . ☑ Pain is an individual , multifactorial experience influenced by culture , previous pain events , beliefs , mood and ability to cope .
Progression of acute to chronic pain
1. Some specific early analgesic interventions reduce the incidence of chronic pain after surgery . 2. Chronic postsurgical pain is common and may lead to significant disability . 3. Risk factors that predispose to the development of chronic postsurgical pain include the severity of pre and postoperative pain , intraoperative nerve injury and psychological vulnerability . 4. Many patients suffering chronic pain relate the onset to an acute incident .
Pre-emptive and preventive analgesia
1. The timing of a single analgesic intervention ( preincisional versus postincisional ) , defined as pre-emptive analgesia , does not have a clinically significant effect on postoperative pain relief . 2. There is evidence that some analgesic interventions have an effect on postoperative pain and / or analgesic consumption that exceeds the expected duration of action of the drug , defined as preventive analgesia . 3. NMDA ( n-methyl-D-aspartate ) receptor antagonist drugs in particular may show preventive analgesic effects .
II. Assessment and measurement of acute pain and its treatment
Measurement
1. Regular assessment of pain leads to improved acute pain management . 2. There is good correlation between the visual analogue and numerical rating scales . ☑ Self-reporting of pain should be used whenever appropriate as pain is by definition a subjective experience . ☑ The pain measurement tool chosen should be appropriate to the individual patient ; developmental , cognitive , emotional and cultural factors should be considered . ☑ Scoring should incorporate different components of pain . In the postoperative patient this should include static (rest) and dynamic (e.g. pain on sitting, coughing) pain ☑ Uncontrolled or unexpected pain requires a re-assessment of the diagnosis and consideration of alternative causes for the pain (e.g. new surgical / medical diagnosis , neuropathic pain ) .
Outcome measures in acute pain management
☑ Multiple outcome measures are required to adequately capture the complexity of the pain experience and how it may be modified by pain management interventions.
III. Provision of safe and effective acute pain management
1. Preoperative education improves patient or carer knowledge of pain and encourages a more positive attitude towards pain relief . 2. Implementation of an acute pain service may improve pain relief and reduce the incidence of side effects . 3. Staff education and the use of guidelines improve pain assessment, pain relief and prescribing practices . 4. Even ‘ simple ‘ techniques of pain relief can be more effective if attention is given to education, documentation, patient assessment and provision of appropriate guidelines and policies . ☑ Successful management of acute pain requires close liaison with all personnel involved in the care of the patient .
☑ More effective acute pain management will result from appropriate education and organizational structures for the delivery of pain relief rather than the analgesic techniques themselves .
IV. Systemically administered analgesic drugs Opioids : 1. Dextropropoxyphene has low analgesic efficacy ( Level 1 ) 2. Tramadol is an effective treatment in neuropathic pain ( Level 1 ) 3. Droperidol, dexamethasone and ondansetron are equally effective in prophylaxis of postoperative nausea and vomiting ( Level 1 ). 4. Naloxone, nalteroxone, nalbuphine and dropeidol are effective treatments for opioid-induced pruritis ( Level 1 ) 5. In the management of acute pain, one opioid is not superior over others but some opioids are better in some patients ( Level 2 ) 6. The incidence of clinically meaningful adverse effects of opioids is dose-related ( Level 2 ) 7. Tramadol has a lower risk of respiratory depression and impairs gastrointestinal motor function less than other opioids at equianalgesic doses ( Level 2 ) اين مبحث ادامه دارد . . .
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