Clinical Management Of Acute Pain Research Articles

Treatment of acute pain in general medical practice

One-third of patients attending a general practitioner’s office have some type of medical problem associated with pain. The most common types of acute pain in patients who consult a general practitioner are musculoskeletal pain in the neck and lower back with or without irradiation to the extremities and joint pain. The primary source of pain is very difficult to ascertain in the usual outpatient setting. However, therapeutic strategies do not directly depend on the primary source of pain, but are based on the pathogenetic mechanisms of pain. Acute nociceptive pain is often accompanied by inflammation, which is a key component of the transition of acute pain to the chronic phase, which should be taken into account when choosing therapeutic strategies. To date, the mechanisms associated with chronic pain are not fully understood due to their complex nature and the involvement of both peripheral and central mechanisms. In addition, complex interacting individual physical (age, female gender and overweight) and psychological factors also affect the transition from acute to chronic pain. The clinical management of acute pain requires an optimal balance between effective pain relief and the associated safety risks. Non-steroidal anti-inflammatory drugs are the most effective drugs for the relief of inflammatory pain. To achieve optimal results, a personalized approach is needed to ensure that the properties of the drugs best match the patient’s characteristics. Because of its multifactorial mechanism of analgesic action, nimesulide is an attractive therapeutic choice for the treatment of patients with acute pain.

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review.

Transdermal buprenorphine is indicated for chronic pain management, but as its role in the clinical management of acute pain is less clear, this narrative review examines studies of the patch for acute pain, mainly in the postoperative setting. Although perhaps better known for its role in opioid rehabilitation programs, buprenorphine is also an effective analgesic that is a Schedule III controlled substance. Although buprenorphine is a partial agonist at the μ-opioid receptor, it is erroneous to think of the agent as a partial analgesic; it has full analgesic efficacy and unique attributes among opioids, such as a ceiling for respiratory depression and low “drug likeability” among those who take opioids for recreational purposes. Transdermal buprenorphine has been most thoroughly studied for acute pain control in postoperative patients. Postoperative pain follows a distinct and predictable trajectory depending on the type of surgery and patient characteristics. Overall, when the patch is applied prior to surgery and left in place for the prescribed seven days, it was associated with reduced postoperative pain, lower consumption of other analgesics, and patient satisfaction. Transdermal buprenorphine has been evaluated in clinical studies of patients undergoing gynecological surgery, hip fracture surgery, knee or hip arthroscopy/arthroplasty, shoulder surgery, and spinal surgery. Transdermal buprenorphine may also be appropriate pain medication for controlling pain during postsurgical orthopedic rehabilitation programs. Transdermal buprenorphine may result in typical opioid-associated side effects but with less frequency than other opioids. Despite clinical reservations about transdermal buprenorphine and its potential role in acute pain management in the clinical setting, clinical acceptance may be hampered by the fact that it is off-label and buprenorphine is better known as an opioid maintenance agent rather than an analgesic.

AN AUDIT OF THE MANAGEMENT OF ACUTE PAIN IN CHILDREN

AimTo evaluate clinical management of acute pain with respect to pain assessment, scoring and timing of analgesia and whether appropriate supportive medicines were prescribed alongside strong opiates. A previous pain...

Antinociceptive synergy between diclofenac and morphine after local injection into the inflamed site

BackgroundCombinations of non-steroidal anti-inflammatory drugs with opioids are frequently used to reduce opioid doses required in the clinical management of acute pain. The present study was designed to evaluate the possible antinociceptive interaction between morphine and diclofenac at peripheral level in male rats. MethodsDrugs were chosen based of their efficacy in the treatment of this kind of pain and as representative drugs of their respective analgesic groups. For the formalin test, 50μl of 1% formalin solution was injected subcutaneously into the right hind paw. The interaction between morphine and diclofenac was evaluated by using isobolographic analysis and interaction index. Drug interaction was examined by administering fixed-ratio combinations of morphine-diclofenac (1 : 1 and 3 : 1) of their respective ED30 fractions. ResultsDiclofenac and morphine reduced flinching behavior in a dose-dependent manner during phase 2 but not phase 1 of the formalin test. Isobolographic analysis showed a synergistic interaction for the combination of morphine and diclofenac after local peripheral administration. ConclusionsData suggest that the combination of morphine with diclofenac at the site of injury is synergistic and could be useful in the treatment of wounds, bruises, rheumatisms and other painful peripheral conditions associated with an inflammatory process.

Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines

Acute, vaso-occlusive pain is the most characteristic complication of sickle cell disease (SCD). Although there has been rigorous work examining the pathogenesis of vaso-occlusion, fewer studies have focused on approaches to the clinical management of acute pain. In this review, we will examine the epidemiology and management strategies of acute pain events and we will identify limitations in the best available studies. Most acute pain events in adults with SCD are managed at home without physician contact. Prior descriptions of the natural history of pain episodes from the Cooperative Study of Sickle Cell Disease relied on physician contact, limiting the generalizability of these findings to current practice. Patient-controlled analgesia has replaced on-demand therapy to become the standard for management of severe pain events in children and adults with SCD requiring hospital admission. Unfortunately, most clinical practice guidelines for the management of acute pain are not based on randomized clinical trials. As a result, our practice of pain management is primarily limited to expert opinion and inferences from observational studies. Additional clinical trials in management of acute pain in children and adults with SCD are critical for the development of evidence-based guidelines.

Influence of attention focus and trait anxiety on tolerance of acute pain.

In light of inconsistencies in the reported effects of attention and anxiety on pain tolerance, this study examined the separate and combined effects of attention focus and trait anxiety on tolerance of acute experimental pain. Participants with 'high' and 'low' trait anxiety were assigned to three attention-focus conditions: pain-focused attention, 'undirected' (no experimenter-induced attempts to influence attention focus) and distraction. Several indices of autonomic arousal (systolic and diastolic blood pressure, heart rate and EMG) were measured before and during, and several self-report inventories were completed before and after, each of two administrations of the cold pressor test. In general, pain tolerance was greater when participants were distracted and in low- rather than high-anxiety participants. However, attention and anxiety interacted such that low-anxiety participants were most pain tolerant, and high-anxiety participants were least pain tolerant, in the undirected condition. The results are consistent with the notion that anxiety fosters attentiveness to possible environmental threats, and might have implications for the clinical management of acute pain.

Clinical management of acute pain

The clinical management of acute pain has been impeded by traditions and misconceptions which have resulted in suboptimal application to the patient of the currently available methods of pain control. The search for new drugs and exotic ways to deliver them has further obscured many of the basic principles which should guide management. Standard regimens fail because of the wide, unpredictable variability in pain intensity, patient characteristics, and pharmacological responses. Treatment needs to be individualized for each patient. Unrelieved acute pain produces psychological, physiological and socioeconomic consequences. Pre-emptive analgesia may damp down the development of both immediate and long-term pain following surgery and adequate psychological preparation can improve coping abilities. The delivery of opioid analgesics can be improved using patient controlled analgesia or spinal administration in some cases. Regional analgesia, often using simple techniques, can produce excellent pain relief. Overall management and staff education should be delegated to an acute pain service.