Management of Acute Pain Flashcards
What is Pain?
“an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
- Individual perception and reaction varies
- Influenced by psychological factors including previous experience
- Influenced by pre-existing pain (acute on chronic)
What are the three types of pain?
- Nociceptive
- No apparent cause
- Neuropathic
What is nociceptive pain?
Can be chronic
Can be acute –> immediate repose/delayed response
What is neuropathic pain?
Acute or chronic
The pain continuum (acute to chronic)
Acute pain:
- Usually obvious tissue damage
- Pain resolves upon healing
- Serves a protective function
Chronic pain (3-6 months)
- Pain for 3–6 months or more
- Pain beyond expected period of healing
- Usually has no protective function
- Degrades health and function
- Can result from dysfunctional activation of pain pathways
When treating acute pain aim to:
- Avoid acute becoming chronic
- Avoid memory of pain causing potentially harmful situation in future
Why is this important for you as Pharmacists?
- RPS survey: Around 35% of pharmacists speak to adult patients about acute pain two-to-five times per day.
- With the introduction of restrictions on prescribing over-the-counter (OTC) analgesics by NHS England, more patients will likely present to the pharmacy for advice.
Where is acute pain a problem?
Community Pharmacy -
Minor Ailments schemes include:
- Backache, strains and sprains, earache, headache
Advice and OTC sales for:
- Menstrual pain
- Migraine
- Post procedural pain
Secondary Care
- Trauma/burns
- Myocardial Infarction
- Kidney Stones
- Childbirth
- Post-operative pain
- Sickle cell crisis
Assessment of acute pain:
- Accurate assessment is essential in the development of a treatment plan:
Consultation skills:
- Where (watch out for colloquial terms!! )
- Intensity
- Anything aggravate pain/ improve pain
- Other symptoms
Before a treatment modality is decided upon:
- Co-morbidity
- Other medications
SOCRATES
What is SOCRATES:
Site– Where exactly is the pain? What body part/joint is involved?
Onset– When did the pain start? Was it constant or intermittent? Gradual or sudden? Is it progressive or regressive?
Character– What is the pain like? An ache? Stabbing? Sharp? Burning? Tight?
Radiation– Does the pain radiate or move elsewhere?
Associations– Are there any other signs or symptoms associated with the pain (e.g. sweating, vomiting, temperature)?
Time course– Does the pain follow any pattern? Is it constant or does it happen at a specific time of the day? How long does it last? When did he/she feel the most pain?
Exacerbating/relieving factors– Does anything change the pain? What makes the pain better or worse? Sometimes, a specific physical position or medication can relieve the pain.
Severity– How bad is the pain? The patient should be asked to give a number to describe the pain on a scale of 0–10, where 0 is the lowest and 10 is the most severe pain experienced.
Step Wise Approach to Pain Management:
- Paracetamol
- Substitute paracetamol for Ibuprofen
- Add paracetamol to Ibuprofen
- Substitute
Ibuprofen
(alt Naproxen). Keep paracetamol - Weak opioid + Paracetamol
And/or NSAID
Don’t keep adding – swap
Opioid is last resort
Analgesia Choice in Children(>3months):
- Paracetamol or Ibuprofen alone as first line
If no response:
- Check adherence
- Check dosing
- Switch
- Alternate dosing
Joint Pain:
Osteoarthritis is a common cause of activity related joint pain. Pain may be managed in community setting
Red Flags include:
- Deformity associated with pain
- Too painful to move / cannot bear weight;
- Severe swelling, discolouration, hot to the touch or bleeding;
- Persistent joint pain, tenderness or swelling;
- Prolonged or severe morning stiffness (more than 30 minutes duration);
- Feeling unwell or presence of fever;
- Tingling or numbness
Back Pain and treatment;
- Range from neck to lower back, buttocks and legs.
- 8 out of 10 people suffer lower back pain at some point in lives
- Important to determine if nociceptive or neuropathic
- Warning signs include: recent trauma or injury, pain down legs and below knees, loss of bladder/bowel control, weight loss –> immediate referral into secondary care
- Use pain ladder to treat. May be prescribed short course benzodiazepines if muscle spasm present.
- Key Messages! Keep moving, painkillers, manual therapy, hot/cold packs, stretching.
Practical issues when using Paracetamol. Doses:
Children:
- 3 to 6 months: 2.5ml of infant susp
- 6 to 24 months: 5ml of infant susp
- 2 yrs to 4 yrs: 7.5ml of infant susp
- 4 yrs to 6 yrs: 10ml of infant susp
- 6 yrs to 8 yrs: 5ml of paracetamol six-plus susp
- 8 yrs to 10 yrs: 7.5ml of paracetamol six-plus susp
- 10 yrs to 12 yrs: 10ml of paracetamol six-plus susp
Adult weight related dosing recommended (BNF) - max daily 4g if >50kg, 3g if 41-49kg, 2g <40kg