ESSENTIAL PAIN MANAGEMENT 1.1 CC BY-NC-SA: This work is licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 3.0 License.
EPM Aims • To improve understanding of pain • To teach a simple framework for managing pain • To reduce pain management barriers 1.2
Workshop Plan 1 • Pain basics • What is pain? • Why should we treat pain? • Classification of pain • Physiology and pathology • Pain treatment • Barriers to treatment 1.3
Workshop Plan 2 • Practical pain management • Case discussions • Overcoming barriers 1.4
Untreated Pain 1.5
Untreated Pain • Often hidden (not recognized) • Causes a lot of suffering • But … can often be treated simply and cheaply 1.6
Approach to Pain • Recognize • Assess • Treat 1.7
Approach to PainR • Recognize • Does the patient have pain? • Do other people know the patient has pain? 1.8
Approach to PainA • Assess • How severe is the pain? • What type of pain is it? • Are there other factors? 1.9
Approach to PainT • Treat • What non-drug treatments can I use? • What drug treatments can I use? 1.10
IntroductionSummary • At the end of this course, you will be able to: • Understand the importance of treating pain • Recognize, assess and treat different types of pain • Identify and address barriers where you work 1.12
What is Pain? 2.1 CC BY-NC-SA: This work is licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 3.0 License.
What is Pain?Aims • To define pain • To give examples of pain 2.2
What is Pain? • Group discussion • Think of a patient / friend / relative who had pain. • How did the person describe the pain? • How was it treated? 2.3
What is Pain? • International Association for the Study of Pain • Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. • What does this mean? • Are there any other definitions? 2.4
What is Pain? • Unpleasant • Emotions are important • The cause is not always visible • “Pain is what the patient says hurts.” 2.5
What is Pain?Summary • Pain is an unpleasant sensory and emotional experience • Pain is what the patient says hurts! 2.8
Why Should We Treat Pain? 3.1 CC BY-NC-SA: This work is licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 3.0 License.
Why Should We Treat Pain?Aims • To understand the reasons for treating pain • To understand the benefits for the patient, family and society 3.2
Case 1 • Mr T is a 29-year-old man with a fast growing mouth cancer that has spread to his bones. He has severe face pain. He is expected to die within 6 months and the surgeons do not want to operate. He is married with two children, aged 11 and 8 • Why should we treat his pain? 3.3
Case 2 • Mrs G is a 54-year-old woman who has just had a laparotomy for bowel obstruction. You see her on the surgical ward soon after the operation. She appears to be in pain. • Why should we treat her pain? 3.4
Why Pain Matters • For the patient • Physical • Suffering, poor sleep, decreased appetite • Medical complications (e.g. heart attack, pneumonia) • Psychological • Depression, anxiety 3.5
Why Pain Matters • For the family • Unable to function as part of the family (e.g. as a father / mother) • Lost income • For society • Greater health costs (e.g. delayed hospital discharge) • Unable to contribute to the community 3.6
Advantages of Treating Pain • For the patient • Fewer physical and psychological problems • Greater dignity (esp. cancer pain) • For the family • Able to function as part of the family • Able to provide for family • For society • Lower health costs 3.8
Why Should We Treat Pain?Summary • Treating pain is the “humane” thing to do! • Treating pain has many benefits • For the patient • For the family • For society 3.10
Classification of Pain 4.1 CC BY-NC-SA: This work is licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 3.0 License.
Classification of PainAims • To classify types of pain • To understand that treatment depends on the pain type 4.2
Classification of Pain • Not all pain is the same! • Three main questions: • How long has the patient had pain? • What is the cause? • What is the pain mechanism? 4.3
Acute versus Chronic • Acute • Pain of recent onset and probable limited duration • Chronic • Pain persisting beyond healing of injury • Often no identifiable cause • (Pain lasting for more than 3 months) 4.5
Cancer versus Non-Cancer • Cancer pain • Progressive • May be mixture of acute and chronic • Non-cancer pain • Many different causes • Acute or chronic Can you give examples? 4.6
Nociceptive Pain • Obvious tissue injury or illness • “Physiological pain” • Description • Sharp ± dull • Well localised Can you give examples? 4.8
Neuropathic Pain • Nervous system damage or abnormality • “Pathological pain” • Tissue injury may not be obvious • Description • Burning, shooting ± numbness, pins and needles • Not well localised Can you give examples? 4.9
Acute Non-Cancer Pain • Examples • Fracture, appendicitis • Symptom of tissue injury or illness • Useful • Usually nociceptive • Occasionally neuropathic (e.g. sciatica) 4.11
Chronic Non-Cancer Pain • Examples • Headache, back pain • Usually no obvious injury • Not useful • Complex, may be mixed nociceptive and neuropathic • Does not respond to usual drug treatment 4.12
Cancer Pain • Examples • Oral cancer, uterine cervical cancer • Features of acute and chronic pain • May be acute on chronic • Often mixed nociceptive and neuropathic pain • Usually gets worse over time if untreated 4.13
Classification of PainSummary • Deciding on the type of pain is important • Acute / chronic • Cancer / non-cancer • Nociceptive / neuropathic • Treatment depends on the pain type 4.15
Pain Physiology and Pathology 5.1 CC BY-NC-SA: This work is licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 3.0 License.
Pain Physiology and PathologyAims • To understand normal pain physiology • Pain pathway • Factors affecting the pain signal • To understand the basis of neuropathic pain(pathology) 5.2
Nociception and Pain • Nociception • How pain signals get from the site of injury to the brain • Pain perception • How we “feel” pain • Nociception is not the same as pain! 5.3
Nociception is not the same as pain! Injury Beliefs/concerns about pain Other illnesses Psychol. factors anxiety/anger/depression Coping strategies Cultural issues Language, expectations Social factors e.g. family, work Pain What the patient says hurts. What must be treated. 5.5 Modified from Analgesic Expert Group. Therapeutic Guidelines 2007