Pain Management Using Medicine Approach
Pain complain is common in Nigeria. This can be attributed to the stressful lifestyle in this part of the world. There are several causes and types of pain. The severity vary between one form of pain to the other.
Pain management makes use of various options suitable for the pain. The choice of approach depends on several factors such as;
1. How intense is the pain?
2. How does the pain feel like?
3. Where is the pain?
4. What makes it worst?
5. When did it start?
Knowledge of the above will give a hint as to the best treatment option. Also, diagnostic approach using;
1. X-ray image for bone alignment
2. MRI or CT scan to help reveal herniated disk or problem with bine, muscles, etc.
3. Blood test for infection
4. Nerve studies using Electromyography which measures the electrical impulse produce by the nerve and the response of your muscles.
Unfortunately the definition of factors like severity is not clear cut as different persons may perceive same degree of pain different. For example, a man may still work with a severe pain while a woman may be crying for same degree of pain. This can hinder proper diagnosis.
a. Psychological treatment
b. Alternative therapy
c. Acupuncture
d. Massage
e. Mind body therapy
f. Nutrition for rheumatism
To achieve better therapeutic response, the cause of pain have to be identified before initiating pain therapy.
Read Also: Treatment Guide For Pain In Stomach Ulcer Patient
According to WHO, the drug of choice for minor pain should be the use of paracetamol or paracetamol with Non-steroidal Antiinflammatory Drugs (NSAID). Nsaids are suitable for muscuskeletal pain. Almost all the Nsaid have same efficacy. The only difference is their tolerance by individuals and side effects. All the Nsaid are contraindicated in patient with history or active stomach ulcer. However, some are milder than others. selective Cyclo oxygenase 2 inhibitors (COX 2) have less effects on ulcer condition than those that act on both COX 1 and COX 2. Unfortunately, selective COX 2 inhibitors have been link with heart risk. Paracetamol is safe when use at the prescribe dose but become deadly when more than 4000 mg is ingested within 24 hours.
Other common side effects include gastrointestinal irritation, heart attack, bronchospasm, increase bleeding time and skin reactions to hypertensive patients.
Nsaid work by reducing the production of protaglandin, the chemical that triggers pain feeling, fever and inflammation while paracetamol works on the part of the brain that receives pain message.
Pain caused by inflammation can best be treated with an anti-inflammatory agents as paracetamol have little or no anti-inflammatory properties. Also, pain caused by infection should be treated with a suitable antibiotic along with a suitable Nsaid.
Nsaid are not to be use for a long time. This is because even they can cause stomach ulcer after a long while. Although some salts of some Nsaids have fewer gastrointestinal disturbance.
Although not in WHO guidelines for treating pain, corticosteroids provide relief from inflamed areas of the body by easing swelling, redness, itching and allergic reactions. They are given in form of oral pills or injection.
Common side effects of corticosteroids include weight gain, upset stomach, weakened immune system, thinning of the bones, etc.
Corticosteroids should be use for a short time too because of their many side effects when use for a long time.
Note: no two drugs from same class should be combined. For example, given ibuprofen and diclofenac even at the right side is wrong. But two pain medication can be combine like paracetamol and ibuprofen.
Muscle relaxants are also use when the other drugs fail to produce therapeutic result.
The above may have little benefits for nerve pains hence some anticonvulsant have proven to be very effective like pregabalin and gabapentin.
There are some cases sedatives and hypnotics are of value such as diazepam. However, it's use is limited due to side effects such as dependence when given over a long period of time.
Muscle relaxants are also effective in alleviating severe pain. In most cases, it is the first drug of choice. A change to opioid is necessary if muscle relaxants fail to yield the needed effect. The main side effect is drowsiness.
A simple way of measuring pain in children is to observe motor responses, facial expressions, crying and sleep/wake pattern. In some cases, physiological response such as blood pressure, pulse changes and palm sweating can be use to measure level of pain in children.
Paracetamol and ibuprofen general have mild side effects in adults. They are also well tolorated in children in treating minor or mild pain. Aspirin should be avoided in children up to 20 years as it's major side effects in children is Reye syndrome which is very bad. This is a condition that is characterise with vomiting, diarrhea, rapid breathing and confusion.
Treating major or severe pain in children may require the use of antidepressants. Antidepressants adjust levels of neurotransmitter in the brain. They can increase availability of the body signal for well being and relaxation. They are better for neuropathy and nerve pain.
Topical Pain medication is added to oral dose as them alone may not give full therapeutic effect desire in the shortest possible time.
a. Epidural steroids injection
b. Pacer joint injection
c. Lumber sympathetic block
d. Cedua flexes block
e. Stella ganglion block
Most of these methods are carried out by medical doctors in ward.
Stomach ulcer normally produce intense pain. A wrong diagnosis may lead to prescription of more pain killers such as Nsaid which will make matters worst.
Stomach ulcer can best be treated with proton pump inhibitors, histamine 2 receptor blocker and antacids. Treating other pains in patient with stomach ulcer is very technical. It will require the use of a PPI or H2 antagonist along with the Nsaid or in some cases selective Cox 2 inhibitors alone.
Read Also: Buy All Nature's Field Products Here
Beta blockers like propranolol is use for prevention in patients that are having frequent attacks. Pizotifen is also another agent of prophylaxis against migraine attacks.
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Pain management makes use of various options suitable for the pain. The choice of approach depends on several factors such as;
1. How intense is the pain?
2. How does the pain feel like?
3. Where is the pain?
4. What makes it worst?
5. When did it start?
Knowledge of the above will give a hint as to the best treatment option. Also, diagnostic approach using;
1. X-ray image for bone alignment
2. MRI or CT scan to help reveal herniated disk or problem with bine, muscles, etc.
3. Blood test for infection
4. Nerve studies using Electromyography which measures the electrical impulse produce by the nerve and the response of your muscles.
Unfortunately the definition of factors like severity is not clear cut as different persons may perceive same degree of pain different. For example, a man may still work with a severe pain while a woman may be crying for same degree of pain. This can hinder proper diagnosis.
Classification Of Pain
Pain can be classified into minor or mild to moderate to severe pain. Treatment option for each category overlap into each other. World Health organisation (W.H.O) provide a general guide on the drug of choice for different degree of pain.Treatment Of Pain
Treatment of pain make do with different approach. The commonest method is the use of oral drug, injections, sprays, lotions and topical creams which we shall discuss in this presentation. The others are;a. Psychological treatment
b. Alternative therapy
c. Acupuncture
d. Massage
e. Mind body therapy
f. Nutrition for rheumatism
To achieve better therapeutic response, the cause of pain have to be identified before initiating pain therapy.
Minor or Mild Pain
Minor pain can be modified with psychological approach and lifestyle modification. The use of drugs help to modify peripheral and central mechanism involve in pain development.Read Also: Treatment Guide For Pain In Stomach Ulcer Patient
According to WHO, the drug of choice for minor pain should be the use of paracetamol or paracetamol with Non-steroidal Antiinflammatory Drugs (NSAID). Nsaids are suitable for muscuskeletal pain. Almost all the Nsaid have same efficacy. The only difference is their tolerance by individuals and side effects. All the Nsaid are contraindicated in patient with history or active stomach ulcer. However, some are milder than others. selective Cyclo oxygenase 2 inhibitors (COX 2) have less effects on ulcer condition than those that act on both COX 1 and COX 2. Unfortunately, selective COX 2 inhibitors have been link with heart risk. Paracetamol is safe when use at the prescribe dose but become deadly when more than 4000 mg is ingested within 24 hours.
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| Drugs for pain |
Nsaid work by reducing the production of protaglandin, the chemical that triggers pain feeling, fever and inflammation while paracetamol works on the part of the brain that receives pain message.
Pain caused by inflammation can best be treated with an anti-inflammatory agents as paracetamol have little or no anti-inflammatory properties. Also, pain caused by infection should be treated with a suitable antibiotic along with a suitable Nsaid.
Nsaid are not to be use for a long time. This is because even they can cause stomach ulcer after a long while. Although some salts of some Nsaids have fewer gastrointestinal disturbance.
Although not in WHO guidelines for treating pain, corticosteroids provide relief from inflamed areas of the body by easing swelling, redness, itching and allergic reactions. They are given in form of oral pills or injection.
Common side effects of corticosteroids include weight gain, upset stomach, weakened immune system, thinning of the bones, etc.
Corticosteroids should be use for a short time too because of their many side effects when use for a long time.
Note: no two drugs from same class should be combined. For example, given ibuprofen and diclofenac even at the right side is wrong. But two pain medication can be combine like paracetamol and ibuprofen.
Moderate Pain
According to WHO, a combination of paracetamol and a weak opioid analgesic like tramadol is suitable for moderate pain. An Nsaid can be use in place of paracetamol. Opioid are to be prescribe and use according to the prescription. Wrong use may lead to dependence. They may not cause dependence if use as prescribe though.Muscle relaxants are also use when the other drugs fail to produce therapeutic result.
Chronic Or Severe Pain
There are several options available to the prescriber. WHO guide suggest strong opioid such as morphine. There are other opioid too such as codeine and dihydrocodeine. Opioids are suitable for visceral pain. Other drugs that can also be use include antidepressants such as amithriptilyn.The above may have little benefits for nerve pains hence some anticonvulsant have proven to be very effective like pregabalin and gabapentin.
There are some cases sedatives and hypnotics are of value such as diazepam. However, it's use is limited due to side effects such as dependence when given over a long period of time.
Muscle relaxants are also effective in alleviating severe pain. In most cases, it is the first drug of choice. A change to opioid is necessary if muscle relaxants fail to yield the needed effect. The main side effect is drowsiness.
Management Of Pain In Children
The main problem of treating pain in children is the ability to predict the severity of pain. This is also the problem encountered when analysing the effect of pain management approach if it is working or not.A simple way of measuring pain in children is to observe motor responses, facial expressions, crying and sleep/wake pattern. In some cases, physiological response such as blood pressure, pulse changes and palm sweating can be use to measure level of pain in children.
Paracetamol and ibuprofen general have mild side effects in adults. They are also well tolorated in children in treating minor or mild pain. Aspirin should be avoided in children up to 20 years as it's major side effects in children is Reye syndrome which is very bad. This is a condition that is characterise with vomiting, diarrhea, rapid breathing and confusion.
Treating major or severe pain in children may require the use of antidepressants. Antidepressants adjust levels of neurotransmitter in the brain. They can increase availability of the body signal for well being and relaxation. They are better for neuropathy and nerve pain.
Topical Pain Medication
Some Nsaids are suitable for treating inflammation from the outside. They include diclofenac. In some preparations, hot topical agents such as menthol is added to enhance its effectiveness.Topical Pain medication is added to oral dose as them alone may not give full therapeutic effect desire in the shortest possible time.
Other Methods Use In Treating Pain
There are several other methods use around the world in treating pain such as;a. Epidural steroids injection
b. Pacer joint injection
c. Lumber sympathetic block
d. Cedua flexes block
e. Stella ganglion block
Most of these methods are carried out by medical doctors in ward.
Special Pains
Stomach Ulcer
 |
| Stomach ulcer |
Stomach ulcer can best be treated with proton pump inhibitors, histamine 2 receptor blocker and antacids. Treating other pains in patient with stomach ulcer is very technical. It will require the use of a PPI or H2 antagonist along with the Nsaid or in some cases selective Cox 2 inhibitors alone.
Migraine
Nsaid are suitable for treating migraine headache. Sulmatroptan which is a 5HT1 receptor agonist can be use in severe migraine attacks. Rarely use Ergot alkaloid because of its side effect such as cerebrovascular and cardiovascular effect. They are nausea, vomiting, abdominal pain and muscular cramps.Read Also: Buy All Nature's Field Products Here
Beta blockers like propranolol is use for prevention in patients that are having frequent attacks. Pizotifen is also another agent of prophylaxis against migraine attacks.
Gout
Just as in other pains, Nsaid are suitable for treating gout at an early stage. Colchine is use when there is an acute attack or the use of allopurinol in chronic conditions.Dental Pain
Minor and chronic dental pain can be handled with Nsaids. Opioids are not effective for dental pain.Dysmenorrhoea
Oral contraceptives can prevent it. In the absence of contraceptive, Nsaids are as effective. Buscopan which is an antispasmodic have been indicated but there is little on its effectiveness in treating dysmenorrhoea. Or maybe when compared with the other available agents.Ear, Eye And Nose
There are ear and eye drops design to be instill into the ear and eyes to treat pain. They contain Nsaids and can be combined with oral Nsaids for quick effect. They are also use before and after eye or ear surgery.Share On Social Media With Family And Friends To Show You Care!
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