PAIN MANAGEMENT MERCHÁN CUENDA, MERCEDES MILÁN RODRIGUEZ, MARÍA MILAGROS MORENO MARÍN, EDUARDO NEVADO VILLAFRUELA, MARINA MUÑOZ GARRIDO, JESÚS ÁNGEL
Acute Gastritis Pain treatment Analgesics Etiologicaltreatment • - Omeprazole. • Clarithromycin: 500 mg PO bid/tid. • Amoxicillin: 500 mg PO qid. • No specific therapy exists for acute gastritis, except for cases caused by • H pylori.
Acute otitis media pain Antibiotics will not provide immediate pain relief and oral analgesics will take a while to help. 3 drops of topical 2% lidocaine drops or benzocaine Rapid pain relief
Acute renal colic pain First-line therapyMetamizol Second-line therapyPethidine
Back pain First-line therapyNSAIDs • Ibuprofen: • 600-2400 PO mg/d q6-8h(600mg/6h). • Naproxen: • 550-1100 PO mg/d. Initialdose: 550mg, followed 275mg q6-8h. Second-line therapy Opioids
Dysmenorrhea First-line therapyNSAIDs • Ibuprofen: • 400 mg PO q4-6h; not to exceed 3.2 g/d. • Naproxen: • 550-1100 PO mg/d. Initialdose: 550mg, followed 275mg q6-8h. Prophylaxis Oral Contraceptives Pill
NEUROPATHIC PAIN Pain caused by lesion or dysfunction of the somatosensory system The most common causesare: • Diabetes mellitus • Post-herpetic neuralgia • Trigeminal neuralgia • Cancer • NON-CANCER PAIN • CANCER PAIN
Post-herpetic neuralgia PREGABALINE • Startwith 150 mg/daily in 2-3 times. • Later 3-7 days, ifitisneccesaryincrease doses until 300 mg/daily in 2-3 times. • Later 7 daysifisnecessaryincrease doses untiltomaximunto 600 mg/ daily in 2-3 times. TOPIC LIDOCAINE 5% patch 24 h. Amitriptilin Capsaicincream TopicalNonsteroidal Anti-inflammatoryDrugs
Trigeminal neuralgia Is an uncommon disorder characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution.
Pain in Diabeticneurophaty First-line agents: Duloxetine (SNRIs) Pregabalin TCAs: amitriptylin Second-line agents: Gabapentin : 900-3000 mg/d Lamotrigine: 400 mg/d Venlafaxine: 150 to 225 mg Tramadol: 50-400 mg/d 60 mg LesssideeffectsthanTCAs and more tolerable: asthenia, constipation, dizziness, dry mouth, hyperhidrosis, nausea, and somnolence. PRECAUTION!!: High blood pressure and heart disease!! No association: TAC, SSRI, MAOI!!
CHRONIC NOCICEPTIVE PAIN Nociceptive pain refers to the discomfort that results when a stimulus causes tissue damage to the muscles, bones, skin or internal organs.
Fibromyalgia:therapeuticagents Relieve depression and painbutnotinsomnia, High blood pressure and heart disease!! No association: TAC, SSRI, MAOI!! Improve relieve and painbutnotinsomnia Relieve insomnia and painbutnotdepression
Fibromyalgiamanagement TRAMADOL, NSAIDs PAIN PREGABALIN DULOXETIN INSOMNIA DEPRESSION
Arthritis The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop progression of RA. Treatment is a multifaceted program: Medications + physical therapy + regular exercise. 1.Nonsteroidal anti-inflammatory drug (NSAID): Ibuprofen (Advil ® or Motrin ®) 2.Steroids: For severe RA, used temporarily . Given as injections directly into an inflamed joint or taken as a pill. Potential side effects of long-term steroid use include high blood pressure, osteoporosis, and diabetes.
Medication is the most popular way to manage osteoporosis pain. 1.Pain medications: Ibuprofen (NSAIDS) Osteoporosis 2.Heat and ice: Warm showers or hot packs
3.Calcitoninis Miacalcin® :For pain in bone fractures. Calcitonin can be taken in a nasal spray, as a shot into the muscle (intramuscular, or IM), or as a shot into the fat tissue (subcutaneous). Side effects of the nasal spray : Runny nose or nasal discomfort. Side effects of the shot : Nausea, vomiting or diarrhea.
■Nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen (Advil ® ) for mild migraines. Excedrin Migraine® (Acetaminophen +aspirin+ caffeine) for moderate migraines ■Triptans. Medications like Sumatriptan ( Imitrex ® ). For severe migraine attacks. Relieve the pain, nausea and sensitivity to light and sound. Side effects of triptans : nausea, dizziness and muscle weakness. They aren't recommended for people at risk for strokes and heart attacks Migraine
Metamizol Naproxen Diazepam Ibuprofen Not use it Not use it Not use it Not use it Metroclopramide Contraindication in lactation Oral contraceptives pills Not use it Omeprazol Paracetamol There is not evidence of fetal risk There is not evidence of fetal risk Pregnancy and Lactation
Oldpeople Again and chronicconditions contribuyed to Limitation in responses to stress in the elderly and management of pain Carefullevaluation of conditions as imperativetopainmanagement Assessment of effectiveness and ADR Physiological alteration in body composition and renal and hepatic funtion alter Distribuition and elimination of medications and metabolites Non-medical treatments ● May be effective in managing pain ●Should be considered for older patiens
Childrens Acetylsalicylicacid Not use it Risks Reye Sindrom Metabolic acidosis (<1 yearold)
35-year-old man come tourgencywithacute renal colicpain. Whatwouldyou do? First-line therapyMetamizol Second-line therapyPethidine
What treatment would you prescribe for a severe migrain? A)NSAIDS B)TRIPTANS
26-year-old womanwithmoderateacutepainduringmenstruation. ¿Whatisthefirst-line therapy? NSAIDsIbuprofenorNaproxen
Whatdrug do you prescribe totreat a trigeminal neuralgia? CARBAMAZEPINE Shouldyouhaveanyprecautionwhitthis?
WEBSITES • http://www.ncbi.nlm.nih.gov/pubmed/ • http://content.nejm.org/ • http://www.thelancet.com/ • http://www.agemed.es/ • http://www.vademecum.es/ • http://www.who.int/ • http://www.diabetes.org/ • www.mayoclinic.com
References: • Engeler DS et al.The ideal analgesic treatment for acute renal colic--theory and practice.2008;42(2):137-42. • Prasad S et al. Use anesthetic drops to relieve acute otitis media pain. 2008 Jan;93(1):40-4. • St. Onge et al. Pain Associated with Diabetic Peripheral Neuropathy. A Review of AvailableTreatments. 2008 Mar;33(3):166-76.2008 March. • TomaszPodolecki et al. Fibromyalgia: pathogenetic, diagnostic and therapeutic concerns.2009 Mar;119(3):157-61.