pain management
TRANSCRIPT
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Pain ManagementVinoo DissanayakeDecember 29, 2006
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Pain
Poena (Latin); fine or penalty. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
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Pain Categories
►Acute►Somatic►Visceral
►Chronic►“Deafferentation
Pain”►“Sympathetically
maintained pain”►Nociceptive►Neuropathic
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Pain Receptors
Nociceptors– Aδ fibers (fast)– C fibers (slow)
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Anatomy of Pain
• Dorsal Column-Medial Lemniscus
• Spinoreticular Tract
• Spinomesencephalic Tract
• Spinothalamic Tract
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Anatomy of Pain
Descending pathwaysNeurotransmitter
release•Enkephalins•Dynorphins•Beta-
Endorphins•Serotonin•Norepinephrine
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The Systemic Response to Pain
► General
► Cardiovascular
► Respiratory
► GI/GU
► Endocrine
► Hematologic
► Immunologic
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Pain Evaluation
► VAS scale and McGill questionnaire
► Minnesota Multiphasic Personality Inventory and Beck Depression Inventory
► Electromyography► Nerve Conduction
Studies► Thermography
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Pain Modulation
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Neural Blockade
Somatic Blocks► Trigeminal Nerve Blocks► Facial Nerve Block► Occipital Nerve Block► Phrenic Nerve Block► Suprascapular Nerve
Block► Cervical Paravertebral
Nerve Block► Thoracic Paravertebral
Nerve Block► Lumbar Paravertebral
Nerve Block► Lumbar Medial Branch &
Facet Blocks► Trans-Sacral Nerve Block► Pudendal Nerve Block
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Neural BlockadeSympathetic Blocks
► Cervicothoracic Block► Thoracic Sympathetic
Chain Block► Celiac Plexus Block► Splanchnic Nerve
Block► Lumbar Sympathetic
Block► Hypogastric Plexus
Block► Ganglion Impar Block► Intravenous Regional
Sympathetic Blockade
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Pharmacologic Methods
► AntidepressantsAntidepressants► AnticonvulsantsAnticonvulsants► NeurolepticsNeuroleptics► CorticosteroidsCorticosteroids► Systemic Local Systemic Local
AnestheticsAnesthetics
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Therapeutic Adjuncts
► Psychological techniques
► Physical therapy► Acupuncture► Electrical
Stimulation
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Outpatient Treatment
► Oral Analgesics► COX Inhibitors► Opioids
► Local Anesthetics
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Inpatient Treatment
► Opioids► Peripheral Nerve
Blocks► Central Neuraxial
Blocks & Intraspinal Opioids
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Cancer Pain
► Oral Opiate Therapy
► Transdermal Opioids► Parenteral Therapy► Intraspinal Opioids► Neurolytic Techniques
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References
• Pain Management. Lange Clinical Anesthesiology. Morgan, Edward, et.al.
• http://www.medscape.com/viewarticle/534650_print
• http://en.wikipedia.org/wiki/Pain
• http://www.emedicine.com/neuro/topic514.htm