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Pain Assessment

The document discusses pain assessment, the WHO analgesic ladder, and the use of oral morphine in pain management. It categorizes pain into physical, social, psychological, and spiritual dimensions and outlines various pain assessment scales. Additionally, it details different classes of analgesics, including non-opioids, weak opioids, strong opioids, and adjuvant analgesics, as well as non-pharmacological treatments and advanced interventional pain management techniques.

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digipoint98
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9 views20 pages

Pain Assessment

The document discusses pain assessment, the WHO analgesic ladder, and the use of oral morphine in pain management. It categorizes pain into physical, social, psychological, and spiritual dimensions and outlines various pain assessment scales. Additionally, it details different classes of analgesics, including non-opioids, weak opioids, strong opioids, and adjuvant analgesics, as well as non-pharmacological treatments and advanced interventional pain management techniques.

Uploaded by

digipoint98
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PAIN ASSESSMENT,

WHO ANALGESIC LADDER &


ORAL MORPHINE
J2B
WHAT IS PAIN..?

• “An unpleasant sensory and emotional experience associated


with or resembling that associated with,actual or potential
tissue damage.”
TOTAL PAIN
TOTAL PAIN

• PHYSICAL PAIN - eg: caused by illness, treatment,co-morbid


factors.
• SOCIAL PAIN – eg: loss of role and social status, loss of job,
worries about future
• PSYCHOLOGICAL – eg: anxiety, depression
• SPIRITUAL – Loss of faith, anger with deity..
1.PAIN ASSESSMENT
PAIN SCALES

UNIDIMENSIONAL MULTIDIMENTIONAL
• Verbal rating scales • Mcgill Pain Questionnare
• Numerical rating scale • Brief pain inventory
• Visual analog scale
• FACES rating scale(Wong-
Baker)
NUMERIC PAIN RATING SCALE
VISUAL ANALOG SCALE
2. WHO ANALGESIC LADDER
MODIFIED PAIN LADDER

• GIVE DRUG BY MOUTH IF POSSIBLE


• GIVE DRUG BY THE CLOCK
• BY THE LADDER
ANALGESICS
• NON OPIOIDS
• OPIOIDS

ADJUVANTS
• TCAs
• Anti convulsant
• Corticosteroids
• NMDA receptor antagonist
• Muscle relaxant
• bisphosphonates
NON OPIOIDS

• PARACETAMOL
DOSE 500 – 1000 mg 4-6 hrs daily

• NSAIDS
useful in metastatic bone and soft tissue pain
inhibit PG synthesis by inhibiting COX enzyme
Eg: diclofenac,ibuprofen,
meloxicam,parecoxib
WEAK OPIOIDS
Codeine,tramadol,dextropropoxyphene
• CODEINE
pro drug of morphine (1/10 potent)
30-60mg q4h
• TRAMADOL
action on opioid receptors
50-100 mg 4-6 hrs daily
STRONG OPIOIDS
MORPHI
• NE
Preparations
• TABLET
Immediate release
controlled release
• Aqeous solution
• Injection
• Bioavailability: 20-30%
• Immediate release – in opioid naïve patient,start 2.5-5mg every 4 hr
• Rescue dose for breakthrough pain
• Supply along with laxative and antiemetics
• If pain relief inadequate or patient taking 2-3 sos dose, increase dos
30-50%
• Side
• Constipation
• Nausea & vomiting
• Signs of toxicity
• Delirium
• Myoclonus
• Drosiness
• Advantage of oral morphine
• No respiratory depression
• No addiction & tolerance
• Oral morphine dose
10-30 mg 4 hrly
ADJUVANT ANALGESICS

• TCA • CORTICOSTEROIDS
MOA: antinflammatoery,anti tumour
Eg: Imipramine,Amiptryptiline
improve mood and appetite
• ANTICONVULSANT Indications
Sodium Valproate Raised ICP
spinal cord compression
Carbamazepine Nerve compression / infiltration
Clonazepam Bone mets. Liver mets & visceral mets
Gabapentine
NON PHARMACOLOGICAL TREATMENT

1. BED REST
2. REHABILITATIVE APPROACH : impove function as well as
pain
 Physical therapy
 Bracing
 Manipulation and mobilisation 3. PSYCHOLOGICAL THERAPIES
 Traction
4. BIOFEEDBACK
 Cervical traction
 Diathermy
 Ultrasound
 cryotherapy
 Exercise
ADVANCED INTERVENTIONAL PAIN
MANAGEMENT

• Continuous delivery of opioids by an implanted intrathecal


pump
• Radiofrequency ablation
• Spinal cord stimulation of chronic intractable pain
THANK YOU

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