Skip to Main Content

++

  • Image not available. It is important, whenever possible, to ask patients if they have pain, to identify the source of pain, and to assess the characteristics of the pain.
  • Image not available. Patients taking analgesics should be monitored for response and side effects, particularly sedation and constipation associated with the opioids.
  • Image not available. Oral analgesics are preferred over other dosage forms whenever feasible, but it is important to adjust the route of administration to the needs of the patient.
  • Image not available. Equianalgesic doses are useful as a guide when converting from one agent to another, but further dose titration usually is required to achieve treatment goals.
  • Image not available. Doses must be individualized for each patient and administered for an adequate duration of time. Around-the-clock regimens should be considered for acute and chronic pain. As-needed regimens should be used for breakthrough pain or when acute pain displays wide variability and/or has subsided greatly.
  • Image not available. For chronic pain that has a maladaptive inflammatory and/or neuropathic component, anticonvulsants, topical analgesics, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and opioids should be considered.
  • Image not available. Whenever possible, a multidisciplinary approach and nonpharmacologic strategies should be used.
  • Image not available. Placebo therapy should not be used as an attempt to diagnose psychogenic pain.

++

Upon completion of the chapter, the reader will be able to:

++

  • 1. Define pain.
  • 2. Describe the epidemiology of pain.
  • 3. Discuss nociceptive painpathophysiology, including stimulation, transmission, perception, modulation, and adaptive inflammation.
  • 4. Discuss and list examples of neuropathic pain.
  • 5. Explain the patient-oriented approach to pain assessment.
  • 6. Characterize the difference between acute and chronic pain.
  • 7. Describe the half-life and usual doses of the nonopioids and opioids indicated for pain.
  • 8. Discuss the pharmacology of the opioid analgesics.
  • 9. Explain the advantages of combining opioid and nonopioid therapy in the management of pain.
  • 10. Outline the management of cancer pain, including drug selection, dosing, monitoring, and patient education.
  • 11. Compare and contrast the treatment of chronic noncancer pain with that of acute pain and cancer pain.
  • 12. Discuss nonpharmacologic treatment options for acute, chronic noncancer, and cancer pain.
  • 13. Explain pharmacologic titration of pain in evaluating therapeutic outcomes.
  • 14. Explain the importance of a multidisciplinary approach to pain.
  • 15. Describe why placebos should never be used to diagnose pain.

++
++

Although the world is full of suffering, it is also full of the overcoming of it.

++

Helen Keller1

++

Humans have always known and sought relief from pain.2 Today, pain's impact on society still is great, and indeed pain complaints remain a primary reason patients seek medical advice.3

++

Regrettably, many healthcare providers do not receive adequate training in this area, and new information is not widely disseminated and/or understood. Clearly, pain management is enhanced when a multidisciplinary approach is applied. Thus, understanding the pathophysiology of pain therapy and maintaining a working knowledge of individual pain regimens are important key ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.