Pain management
Learning objectives
At the end of the workshop you will be able to:
• Consider the important principles of pain and pain
management
• Use validated tools to assist in assessing patients pain
• Outline strategies to manage pain with your patients
• Discuss pain medicines with your patients
What is pain?
• A message to the brain, pain is a
’whole body’ experience and involves
both the mind and the body
• Usually a protective mechanism to
warn us to be more careful of our
bodies
• It hurts and may cause suffering or
distress
• Different for different people: it is
whatever the person says hurts
Types of pain
•
Acute pain can be important for
the body to tell the brain that
there is something wrong and
help to avoid harm.
•
Chronic pain is pain that goes
on for a long time. It needs
regular assessment and a
different approach to treatment.
Chronic pain impacts on the whole person and
their community
Ask your patients about any
changes that have
happened in their lives since
their ongoing pain started.
For example:
•
How are you sleeping?
•
Are you feeling worried or sad?
•
Are you still visiting friends or
relatives?
•
Are you eating well?
Things to talk about:
•
How pain is affecting their life
•
Where the pain is, how bad the pain is
•
How long they have had the pain
•
What medicines they are taking for the pain
(and any other conditions)
•
How the pain has affected them and their
family
•
If they have any other problems or worries
•
Make sure people understand that it may not
be possible to be pain-free at all times
•
Anticipation of pain
How do we assess pain
Ask the patient:
•
To describe their pain
•
Rate their pain (use the faces scale based on
how they perform everyday activities)
•
What made the pain worse or better
REMINDER:
Observe the person’s body language (how freely
do they move).
Talk with the person about how they feel, and
how it affects their everyday life
Talk with their family when appropriate
Make sure people understand that it may not
be possible to be pain-free at all times
Use the same pain assessment
tool to keep a detailed record of
the patients’ pain changes in the
clinic notes.
Managing chronic pain
Treatment goals:
• To improve the level of activity
• To modify thoughts about pain
and suffering
• To promote self-management
• To relieve pain to a tolerable level
Managing chronic pain
Tips on helping people to exercise
•
Educate patients that there is a
difference between ‘hurt’ and ‘harm’
when you have chronic pain. Avoiding
physical activity can make their pain
seem worse over time.
•
Encourage patients to talk to their
family and friends and not isolate
themselves. Also get a family member
or friend involved as their ‘exercise
buddy’.
•
You may wish to suggest some
exercises to try e.g. walking,
swimming, gentle stretching
exercises. Remember to start slow
with exercise as they may feel some
discomfort initially, especially if they
have been inactive for a long time.
Medicines
Key points:
•
Use a step-wise approach to
introduce pain medicines
(analgesics)
•
Prescribe regular doses of
analgesics
•
Plan a trial period with clear and
specific instructions
•
Review the effects on regular basis
eg may need more frequent review
for new medicines or when dose
changes
Analgesics – Non-opioid analgesics
AMH 2010, CARPA 5th edition
Nonsteroidal anti-inflammatory drugs (NSAID)
Generic
names and
how given
Other
NSAIDS
Diclofenac Indomethacin Ketoprofen Ketorolac
Mefenamic acid Naproxen Piroxicam
Tiaprofenic acid
Cox-2 Inhibitors: Celecoxib Meloxicam
Parecoxib
What it is
used for
Mild to moderate pain and fever
Reduces swelling and inflammation in arthritis , period
pain, sprains and injuries or attacks of gout
Renal colic
Suppositories are used when the patient is vomiting
.They can still cause stomach pain when used for long
period s
Gels can be used as a rubbing medicine
Can be used with other medicines
How it
works
Prostaglandins in the body cause redness, swelling and
pain at the site of injury. NSAIDs stop the body making
prostaglandins
Adverse
effects
AMH 2010, CARPA 5th edition
Short-acting and long-acting opioids
Short-acting opioids
Long-acting opioids
codeine
Modifies release tramadol
Methadone
Tramadol
hydromorphone
Immediate-release morphine
Immediate-release oxycodone
Immediate-release tramadol
Modified-release
hydromorphone
Modified-release morphine
Modified-release oxycodone
Transdermal buprenorphine
Transdermal fentanyl
Opioid analgesics – Combination analgesics
Generic
PARACETAMOL +
names and Codeine 30 mg
how given (Panadeine Forte ®, Codalgin Forte ®)
What it is
used for
Moderate to strong pain relief
Can be used in combination with other pain relief
medicines
How it
works
Two different medicines work
together (but in different ways)
in the brain and nerve ending
to reduce pain
Adverse
effects
•Drink lots of water to prevent constipation
Laxatives may be needed
• Return to the clinic if need to
Use for more than a short time
•If you take more than 8 tab lets a day
containing paracetamol you can damage your
liver (make sure there is no paracetamol in
your other medicines)
Opioid analgesics - Morphine
AMH 2010, CARPA 5th edition
Opioid analgesics - Tramadol
Generic names
and how given
TRAMADOL
What it is used
for
Moderate to severe pain
Slow release formulations
are used for chronic pain
How it works
Adverse effects
AMH 2010, CARPA 5th edition
Drug interactions (do not take with)
Warfarin SSRI Venlafaxine
Carbamazepine St John’s Wort
Take home messages
When you see a person who has pain:
• Perform a thorough history and physical examination to
determine if referral is necessary
• Discuss options for managing pain with the person
• Recommend medicine only as part of an agreed pain
management plan
Resources
•
Australian Pain Management Association’s Pain Link Helpline (1300 340 357)
•
Australia’s National Phone Information and Support line
(1800 218 921) Provide support for patients, their carers and health professionals.
•
Chronic pain Australia – www.chronicpainaustralia.org
Your name
Contact details