Treatment of pain

Treatment of pain

The treatment of the pain depend on the causes of the pain and also on types of the pain either acute or chronic pain

Drugs used in treatment of the pain

These drugs can be classified into three steps used as analgesic ladder means used first mild drugs effects to moderate and potent analgesic
Analgesic ladder
Steps 1 Simple analgesics such as paracetamol and non steroids anti-inflammatory drugs NSAIDs

Steps 2 used compound analgesic such as co-proxamol or co-codamol

Steps 3 Used opiate such as morphine

Which routes of these drugs can be taken

The route of administration of analgesic can by given by oral route or intramuscular route intravenous route by either continuous infusion or by patient controlled analgesia subcutaneous, transdermal such as dermal patches sublingual  such an under the tongue rectal through anal canal inhalational epidural and spinal nearly by all route


Mild analgesic has no anti-inflammatory activity

Non- steroidal anti-inflammatory drugs
   
Such as ibuprofen,diclofenac

Has anti- inflammatory,analgesic and antipyretic actions

Mechanism of action acts by inhibition  synthesis of prostaglandins by inhibition of the enzyme cylco-oxygenase
They acts mainly peripherally but have some central action

Opioid analgesics

Examples morphine diamorphine fentanyl
  Causes analgesia euphoria and anxiolysis

Acts centrally and peripherally at opiate receptors such as mu kappa and delta receptors

Patient controlled analgesia

 More common used nowadays for postoperative pain which it is given by patient demands when patient feel pain can pressing a special controlled pump connected to the patient by a button on his hand on pressing it leads to release the analgesia

Treatment of chronic pain

Chronic pain is pain persists for long time period when it would be expected that healing is complete for more see here
 
  Treatment of chronic pain need functional rehabilitation

Drugs can be used to treated chronic pain are

Non steroids anti-inflammatory drugs

Long acting opioids eg transdermal fentanyl

Anti-epileptics drugs eg gabapentin ,lamotrigene

Antidepressants drugs for neuropathic pain


Follow the analgesic ladder may require opioid analgesia as above

Aim for regular oral medication

Radiotherapy can provide pain relieve


CT- guided stereotactic per-cutaneous destructive procedures
  
Treatment the causes of the pain
 Causes types of the pain see here
  

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