- 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.
- 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 neuropathic component, anticonvulsants, topical analgesics, tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors, and opioids should be considered based on evidence-based recommendations when 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.
- 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.
- Patients taking analgesics should be monitored for response and side effects, particularly sedation and constipation associated with the opioids.
- Care should be taken to identify and avoid potential drug–drug interactions with analgesics when possible, as increased adverse effects may occur (e.g., opioids and benzodiazepines).
- Whenever possible, a multidisciplinary approach and nonpharmacologic strategies should be used.
- Etiology of pain may not always be identifiable.
On completion of the chapter, the reader will be able to:
Describe the epidemiology of pain.
Discuss nociceptive pain pathophysiology, including transduction, transmission, perception, and modulation.
Discuss and list examples of neuropathic pain.
Explain the patient-oriented approach to pain assessment.
Characterize the difference between acute and chronic pain.
Describe the usual doses of the nonopioids and opioids indicated for pain.
Discuss the pharmacology of the opioid analgesics.
Explain the advantages of combining opioid and nonopioid therapy in the management of pain.
Outline the management of cancer pain, including drug selection, dosing, monitoring, and patient education.
Compare and contrast the treatment of chronic noncancer pain with that of acute pain and cancer pain.
Discuss nonpharmacologic treatment options for acute, chronic noncancer, and cancer pain.
Explain why the elderly and very young are at higher risk than other populations for under-treatment of pain.
Explain pharmacologic titration of pain in evaluating therapeutic outcomes.
Explain the importance of a multidisciplinary approach to pain.
If we know that pain and suffering can be alleviated, and do nothing about it, then we ourselves, become the tormentors.
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 pain regimens are important factors in addressing ...