- 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.
- Patients taking analgesics should be monitored for response and side effects, particularly sedation and constipation associated with the opioids.
- 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.
- 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.
- 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.
- 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.
- Whenever possible, a multidisciplinary approach and nonpharmacologic strategies should be used.
- 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.
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 ...